ACCOUNTS OF THE CONTINGENCIES FUND 2005-06

Ordered,
	That an humble Address be presented to Her Majesty, That she will be graciously pleased to give directions that there be laid before this House the accounts of the Contingencies Fund, 2005-06, showing—
	(1) a balance sheet
	(2) a cashflow statement, and
	(3) notes to the account; together with the Report of the Comptroller and Auditor General thereon.— [Mr. Michael Foster.]

Oral Answers to Questions

NORTHERN IRELAND

The Secretary of State was asked—

Water Charges

Roger Berry: What plans he has to assist those on low incomes following the introduction of water charges in Northern Ireland.

David Cairns: As part of our investment and reform programme for water services, we are introducing measures to guarantee that more than a quarter of homes, about 200,000 households, spend no more than 3 per cent. of their income on water and sewerage charges. To ease further the burden for all customers, all new charges will be phased in over three years and for pensioners we are making available the option of choosing a water meter.

Roger Berry: I very much welcome my hon. Friend's statement. Can the House be assured that those eligible for assistance will receive it automatically and will not have to go through any cumbersome application procedure?

David Cairns: My hon. Friend makes an extremely important point. We want to be proactive in ensuring that those who are entitled to the additional support actually receive it. That is why we have already put in place data-sharing arrangements with the Housing Executive and the Rate Collection Agency, to ensure that people entitled to the relevant benefits actually receive the support. That is a mark of how serious we are about ensuring that those on lower incomes receive the help and support that we are making available.

Patrick Cormack: Should not the details be left to the Northern Ireland Assembly? Will the Minister give an unequivocal guarantee that no irreversible decisions will be taken before 24 November?

David Cairns: I remind the hon. Gentleman, who has detailed knowledge of the history of these matters, that the process was begun under the Executive and the last Assembly, and that we have followed through the work they began. Of course, delaying the process beyond the start of April 2007, when it is due to come into force, would put a big hole in the budget for next year. An incoming Assembly would be free to reverse the process, but it would have to find the money to keep the investment going into water and sewerage services that they desperately need. If we are not to do that by asking people to pay a fair share domestically, the money will have to come from other parts of the budget—from health, education and training and skills—and I do not think the people of Northern Ireland would welcome that either.

Eddie McGrady: I would like to reiterate my total opposition to the introduction of water rates, which are already collected under the regional rate. However, the Minister's colleague wrote to me on 9 September citing Government policy in respect of rates and said:
	"The Government's view is that a rate relief scheme based on ability to pay best reflects the situation in Northern Ireland."
	How does the Minister square that statement of the Government's policy and philosophy with the fact that he is not abiding by it in respect of the water rates, the little-mentioned sewerage rates or the general rate itself? Why the contradiction?

David Cairns: The hon. Gentleman has to face up to a simple fact: domestic households pay in council tax and water charges about £1,300 in England and Wales, £1,250 in Scotland and £668 in Northern Ireland. That is not sustainable if we want the investment in water and sewerage services that is needed to bring them up to the standards required. The process is a way of ensuring that people pay a fair share—not more than their fair share. At the same time, we have what we call an affordability tariff—help for those on lower incomes—that is far more generous than anything that applies elsewhere in the United Kingdom. We should be commended for a package of measures that gives the investment we absolutely need, is fair to everyone and gives support to those on low incomes.

Nigel Dodds: The Minister will be aware that the General Consumer Council for Northern Ireland has launched legal action in an attempt to win more time for consultation, because people across the communities in Northern Ireland, especially vulnerable people, are very worried about what the Minister proposes to do. Will he give a guarantee that he will extend the consultation period, in line with what the General Consumer Council and all the parties and the people of Northern Ireland are seeking? Can he at least give that assurance?

David Cairns: This matter has been under consultation since 2001. The idea that the consultation period has been shortened is absolute nonsense. The matter comes before the court tomorrow, but on the general principle the consumer council supports the introduction of water charges. It has worked with us because it recognises that, if we are to have the investment we need to bring water and sewerage services in Northern Ireland up to an acceptable level, people—domestic consumers—have to pay their fair share. The consumer council supports that policy. I am absolutely convinced that we have consulted properly, thoroughly and rigorously on it, and we shall not delay it any longer.

Ring-fenced Funds

Martin Linton: What assessment he has made of the merits of using ring-fenced funds to target specific policy areas in Northern Ireland.

Peter Hain: I have established three ring-fenced priority funding packages—children and young people, skills and science and environment and energy—to redirect resources specifically to improve the prospects and life chances of future generations in Northern Ireland.

Martin Linton: I am sure that the House will be pleased to hear about the progress of that approach, but are there other ways in which different Departments can work together—for instance, through cross-cutting budgets in respect of areas such as renewable energy?

Peter Hain: There are indeed and I welcome my hon. Friend's point. That is exactly what is happening. For example, we are seeing £60 million invested in renewable energy schemes and environmental protection schemes to make Northern Ireland the leader of the green agenda in the United Kingdom. There are also 100 per cent. grants to low-income households to install solar panels on their roofs, alternative microgeneration schemes and a change in building regulations, so that, from April 2008, no new build in Northern Ireland—whether it be a hospital, a school, a factory, an office or a home—can proceed without microgeneration designed in from the beginning. That will contribute to the fight against climate change, as well as reduce bills.

Iris Robinson: The Secretary of State will be aware that the DUP was the only party to argue for a reduction in the number of Government Departments. Does he agree that it is imperative for the funding for the distribution of essential life-improving drugs such as Herceptin, beta interferon, Enbrel and Remicade on the one hand, and for mental health provision on the other, to be ring-fenced? Sadly, in those two areas, money is often siphoned off when there are shortfalls within the national health service.

Peter Hain: The hon. Lady will know that the Labour Government have doubled in real terms the health budget in Northern Ireland, but she has made strong arguments on those matters and I pay tribute to her. It is exactly the joined-up government approach that we are carrying forward and I hope that the devolved Executive will also carry it forward—and sooner rather than later.

Chris Ruane: I congratulate the Secretary of State on the ring-fenced funding and I ask him to think seriously about further ring-fenced funding for education. While there are wards in North Down where 70 per cent. of young people go to university, only 4 per cent. do so in the Shankhill. Such disparities cannot go on and extra ring-fenced funding will help to overcome them.

Peter Hain: My hon. Friend is absolutely right. Although Northern Ireland has excellence at the top of our schools system, it has a very poor achievement rate down the ability ladder. What we need is everyone having opportunities in schools so that Northern Ireland can be world class. That is why I have ring-fenced funding for children and young people. For example, I have provided extra money directly to head teachers in about 400 schools in the most disadvantaged areas—including the one that my hon. Friend mentioned—to enable them to run breakfast and after-school clubs, providing high-quality care, so that parents can work if they wish to and children can get a better start in life. We are also offering a new pre-apprenticeship programme to young people at 14, so that they stay engaged in education and are fully prepared for further vocational education. That is our agenda.

Victims (Funding)

Jeffrey M Donaldson: What plans he has to review funding for the victims' sector in Northern Ireland.

David Hanson: Since 1998, the Government have provided £36.4 million of help to victims. As part of her remit, Mrs. Bertha McDougall, the Interim Commissioner for Victims and Survivors, is carrying out a review of how well current funding arrangements are addressing need. Her final report is due around the end of this year and I look forward to seeing her findings and recommendations, which will help to inform our consideration of any new funding arrangements.

Jeffrey M Donaldson: The Minister will be aware that in a recently published report, Bertha McDougall stated that there was a
	"lack of co-ordination, which had led to confusion, duplication of funding, gaps in funding, over-administration and an incomplete picture of provision."
	In advance of the interim commissioner's final report, is there not a need to look further into how to end the duplication and to ensure that the money gets through to the people who need it most—the people who have suffered: the victims and the survivors—rather than be spent on administration? There should also be greater flexibility with respect to the Northern Ireland memorial fund. The funding should be geared towards meeting the specific needs of individual victims rather than provide generalised funding through grant arrangements.

David Hanson: The hon. Gentleman makes some very fair points. I congratulate Bertha McDougall on her work to date as interim commissioner. She is doing a sterling job in reviewing these issues. As the hon. Gentleman said, she has identified a lack of co-ordination, duplication of funding arrangements and the fact that, in some cases, bureaucracy is preventing victims, through no fault of their own, from receiving what is due to them. That is the very reason why we asked her to examine the issues and the very reason why she will make proposals in December. I greatly share the hon. Gentleman's aspiration for a more focused and targeted approach to funding for victims and for people who need Government support, so that they receive it in a proper and effective way. I am confident that, once the review is complete, we will be in a position to take those matters forward.

Mark Durkan: I thank the Minister for the comments that he has already made on this important issue. Does he recognise that, as we look to political progress in the talks in Scotland and beyond, every stage of progress has brought mixed feelings for victims in Northern Ireland? They do not reject the language of moving on, but they fear that they are being left in some sort of forgottenhood. Does he recognise that the promises made to victims in the Good Friday agreement have not been upheld? The Government and all the parties can do more to deliver those promises. Will he encourage the formation of a forum for victims and survivors to do the business that the parties and Governments have failed to do in addressing the needs of victims on truth, remembrance and recognition?

David Hanson: Again, there is much in what my hon. Friend says that I genuinely share. Bertha McDougall, as the interim victims commissioner, is examining the possibility of bringing together individuals to look at some of the issues that deal with the past. What has happened in Northern Ireland over the past 35 years and the impact on victims and survivors has been devastating to their lives, cannot be moved on from and will always need to be remembered, but it needs to be put into a context where we offer support and accommodation to examine those issues in detail. We will very shortly introduce into the Commons an order to establish the victims commissioner permanently. We are committed to an expenditure of about £5 million a year on victims currently, and we have spent more than £36 million to date. I am certainly discussing the points that my hon. Friend mentions with the victims commissioner now, and I hope that we can make progress on them in the near future.

Lembit �pik: Has the Minister examined the Alliance party's proposals for an international commission to define a strategy that deals not just with the past, but with the legacy of the past and the victims of what has happened in the past three and a half decades? Do the Government share my view and, indeed, that of the Alliance party that Northern Ireland must have a strategy to address its past if it is successfully to implement a vision for a shared future?

David Hanson: Yes, I have seen the Alliance proposal and I congratulate David Ford MLA on bringing those ideas to the table. I am also very encouraged that the Committee on the Preparation for Government in the Assembly has looked seriously at issues that relate to the past, and we certainly need to give careful thought to how we deal with such issues. I welcome the paper from the Alliance as a contribution to that debate. There is certainly the potential for some form of consultation on dealing with the past, and we continue to keep that under review. No doubt, that will be discussed as we head for Scotland today and over the next few days as well.

David Lidington: Since victims groups were probably the most strongly opposed to the Government's abortive Bill to give an effective amnesty to on-the-run terrorists, will the Minister give us an assurance today that the Government will not agree to this week's demand from Sinn Fein that that legislation now be reintroduced?

David Hanson: I am grateful to the hon. Gentleman for raising that issue. He will know that the Government attempted to take action on this issue. That attempt was not successful. The Government withdrew the Bill, and I can assure him today that there is no prospect whatsoever of the Government reintroducing the legislation that was before the House last year.

Unemployment

Kali Mountford: What steps he is taking to assist back into work those in Northern Ireland who are economically inactive.

Maria Eagle: Despite the fact that the Northern Ireland economy is supporting its highest ever number of jobs and has below-average unemployment, it is still one of the worst economic inactivity hotspots in the UK. In Northern Ireland, a person of working age is 74 per cent. more likely to be receiving incapacity benefit than a working-age person in England. Therefore, we are implementing the pathways to work programme for people who receive incapacity benefit and have increased funding over the baseline by an additional 3.7 million over the next two years from the new skills and science fund to achieve that.

Kali Mountford: I thank my hon. Friend for that answer, but given that the economic success of any community depends on the economic activity of individuals, is it not important to monitor closely how pathways to work can work best for individuals? In doing so, can we ensure that that programme is available to all the people of Northern Ireland, so that everyone can share in the success?

Maria Eagle: My hon. Friend may be aware that the pilots operating in six areas are showing extremely encouraging results, with up to five times more people finding work in those areas following the interventions than in other areas. By the time we roll out pathways to a further four areas this month, we will be covering about a third of the on-flow on to the benefit. I hope that we will be able to roll out the programme further across the whole of Northern Ireland over the next year or so, meaning that everybody in Northern Ireland coming on to incapacity benefit will have the benefit of pathways to assist them back into work and economic activity.

David Simpson: In March this year, we were told that one of the key issues that the Government have to address in supporting the economically inactive back into the workplace is skills. What progress has been made in that area?

Maria Eagle: The hon. Gentleman is right, in that the economically inactive are twice as likely to have no qualifications as those who are in work, so developing key skills and giving people access to skills training is an essential part of our approach. In respect of those who have been inactive for some time, confidence-building measures and helping them to deal with the health conditions that often keep them on incapacity benefit are vital first steps. Both interventions need to go forward together, and they will as we roll out pathways to work.

Equality Bill

Mark Hendrick: What he expects the effect of the proposed Equality Bill for Northern Ireland to be; and if he will make a statement.

David Hanson: The single equality Bill will bring together all existing Northern Ireland equality and anti-discrimination law in one legal instrument and, as far as is practicable, harmonise protection and extend protection to new grounds where appropriate. The resulting legislation will be more consistent and coherent, will clarify rights and responsibilities and will simplify the law to make it more effective.

Mark Hendrick: The former Secretary of State for Northern Ireland, the late right hon. Member for Redcar, was instrumental in setting up the Equality Commission for Northern Ireland, which is responsible for dealing with sexual discrimination, disability discrimination, fair employment and race relations. The single equality Bill has been consulted upon for several years, but when will this legislation finally become law?

David Hanson: I pay tribute to my former right hon. colleague, Mo Mowlam, who put a lot of work into ensuring that the single equality Bill came before the House. As Ministers, we are determined that Northern Ireland will not fall behind the rest of the United Kingdom in terms of the introduction of legislation. There is potentially about one year for work to be undertaken and we are committed to undertaking the legislation either by a Bill in the House or via the devolved Assembly if that is the appropriate way forward. As the direct rule ministerial team, we certainly wish to see the legislation before the House.

Gregory Campbell: Will the Minister accept that any proposed equality Bill needs to ensure that, for example, the public sector recruitment ratios that have shown in recent years a significant under-representation of the Protestant community are addressed and reviewed so that genuine equality of opportunity is offered to each section of our community?

David Hanson: I certainly understand the hon. Gentleman's point. I wish to see more people from the Protestant community employed in the sectors that he mentioned. I ultimately want to see people treated as equals and not on the basis [ Interruption. ]

Mr. Speaker: Order. There is far too much noise in the Chamber and that is unfair. [Hon. Members: Hear, hear!] I am glad so many hon. Members agree with me.

David Hanson: I wish to see a situation in Northern Ireland in which all individuals are treated as equals and on their merits. That is what the legislation is about and that is why I hope that we will bring it before the House in due course.

Rating Reform

Stephen Pound: What steps he is taking to help those on low incomes during the introduction of rating reform in Northern Ireland.

David Hanson: The Government are committed to introducing a fair rating system for Northern Ireland based on the current value of people's homes. Through housing benefit and the new rate relief scheme, more than 185,000 households in Northern Ireland will receive assistance in paying their rates. In addition, those in full-time education and training, as well as all 16 and 17-year-olds and young people leaving care up to the age of 21, will be exempt from rates.

Stephen Pound: I am very grateful to my hon. Friend for that comprehensive and welcome response, which is an example of reform tinged with sensitivity. As he now wears proudly the mantle of champion of the elderly, is he not aware of the 250,000 pensioners in Northern Ireland and will he not look at special support for a group that may be property rich but are often cash poor?

David Hanson: I am grateful to my hon. Friend. He will be aware that I have taken on the role of older people's champion. Older people, for this purpose, are determined as those over 50, and I am 49 and a half, so I am just about there. The Government are committed to introducing a fair rating system, and the number of people who will receive benefits for their rates will increase as a result of the changes that we are bringing forward. Under the old rating system, some 175,000 people had help with their rates. Under the new proposals, 185,000 will have help and more of those will have greater benefits than before. I am committed to ensuring that people on low incomes have the best deal possible from this Government in paying their rates.

William McCrea: What help will be given to pensioners paying their rates who live in their own homes but support a family member in care? If there is a 5 per cent. cap in England, why is there not one in Northern Ireland?

David Hanson: We have tried to put in place a new benefits system that will help those in need to pay. There are many well-off pensioners who might not benefit from any schemes, but there are many low-income pensioners who will benefit from rate relief. The circumstances differ, but overall more people will benefit under the proposed new scheme.
	I have taken a decision not to cap the rates in due course. That will affect approximately 3,000 properties. There are 700,000 properties in Northern Ireland. I am concerned about ensuring that the system is fair for the vast majority of propertiesthose who live in the largest properties can afford to pay a significantly increased contribution to their rates. That is my objective, and I hope that the hon. Gentleman, and in due course the Assembly, will share it.

Alasdair McDonnell: I welcome the Minister's answers relating to those on low incomes, but unfortunately, unlike the hon. Member for Ealing, North (Stephen Pound), I do not believe that they will work out in practice. Does the Minister accept that the parameters of low income are far too tight and that many people with pensions and very small savings will not qualify for any relief? Does he accept that people with disabilities will require their homes to be specially adapted before they qualify? There is a plethora of single-person households, carers and all the rest who will not qualify for relief.

David Hanson: No, I am afraid I do not accept that. To give an example, a pensioner couple living in a house worth 500,000 with a combined pension and income of 21,000 and 15,000 in savings will still benefit under the rate relief scheme. I believe that the scheme is fair and appropriate, and I commend it to the House.

Laurence Robertson: By the very nature of the scheme, more people will be paying higher rates, and that will lead to a lower disposable income across Northern Ireland. That will lead to lower demand for goods and services, and that will lead to fewer jobs. How does the Minister square that with his intention to make more people in Northern Ireland economically active?

David Hanson: Our figures show that 55 per cent. of the population of Northern Ireland will pay the same or less in their rates than currently. We are not raising one single extra penny from the rating system in Northern Ireland. We are rebalancing that system and ensuring that it is fair for all.

Northern Ireland Assembly

David Anderson: What progress has been made with the restoration of the Northern Ireland Assembly.

Peter Hain: Substantial progress has been made in recent months, including a report of the Independent Monitoring Commission, which opens the way to a settlement at the summit at St. Andrews that will start later today.

David Anderson: I thank my right hon. Friend for that reply. The whole House should welcome the progress that has been made and hope that more progress will be made this week. Have any specific discussions taken place that will allow the hundreds, if not thousands, of people who have been forced into exile over the past 30 years to return to their homes in safety?

Peter Hain: As my hon. Friend knows, the security situation has been transformed these last years under this Government, with not one soldier on the streets on 12 July for the parading season for the first time in nearly 40 years, and with last week's IMC report confirming that the Provisional IRA no longer has a war machine and no longer poses a terrorist threat. That opens the way for delivering a political settlement, starting in St. Andrews today.

Peter Robinson: Is the Secretary of State aware of how damaging it would be to the prospects for restoration [Interruption.]

Mr. Speaker: Order. The hon. Gentleman should be heard on this matter.

Peter Robinson: Thank you, Mr. Speaker.
	Is the Secretary of State aware of how damaging it would be to the prospects for restoration if the Government were to return to the issue of on-the-run terrorists being given what amounts to an amnesty? Although we welcome the earlier answer from the Minister of State that no legislation is to be brought before the House, will the Secretary of State reassure the House and settle the nerves of my colleagues and me by assuring us that no other procedure will be used to allow on-the-run terrorists to return?

Peter Hain: There is no other procedure. There is no prospect of an amnesty. The legislation was tried; it was withdrawn when support for it collapsed, not least in this House, and we have absolutely no intention of bringing legislation back. That, I think, should reassure the hon. Gentleman. What we shall look for in the next few days is deliverynot promisesfrom Sinn Fein on policing and respect for the rule of law, and then a commitment from all the parties to a power-sharing Executive.

David Lidington: First, may I wish the Secretary of State and the Northern Ireland parties well in their negotiations at St. Andrews?
	Secondly, may I ask the right hon. Gentleman to confirm that he believes that if power sharing and devolution are to be durable in Northern Ireland, as we both want, they must be based on every political party and every potential Minister recognising the authority of the police and the courts as legitimate, and giving those institutions full practical support?

Peter Hain: I am grateful for the hon. Gentleman's support. The discussions will be critical. The politicians have a window of opportunity, which may not be available again for many years to come.
	I am happy to agree unequivocally that Sinn Fein and everybody else must sign up to the rule of law. Anyone who seeks to hold ministerial office in Northern Ireland must support, co-operate with and report crime to the police, and ensure that the Police Service of Northern Ireland is able to do its job of enforcing law and order.

PRIME MINISTER

The Prime Minister was asked

Engagements

Michael Jabez Foster: If he will list his official engagements for Wednesday 11 October.

Tony Blair: Before listing my engagements, I am sure that the whole House will join me in sending our sympathy and condolences to the families of those members of our armed forces who have lost their lives in action in Iraq and Afghanistan over the past few months. We pay tribute to their courage, their bravery and the importance of the work they do. This country is proud to have the armed forces that we have.
	This morning, I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall have further such meetings later today, including, of course, hosting the talks on the future of Northern Ireland.

Michael Jabez Foster: The excellent accident and emergency and maternity services at Hastings Conquest hospital are testimony to the massive improvement under Labour's national health service[Hon. Members: But.] There are no buts. However, may I ask my right hon. Friend how local people can challenge the bizarre proposals by bureaucrats to downgrade those valued and cherished services?

Tony Blair: My hon. Friend is right to say that there has been enormous progress in the health service. Waiting lists are down by some 400,000. The number of deaths from heart disease has fallen since 1997 by about 150,000. We now have no one waiting for more than six months; when we took office, thousands were waiting more than 18 months. There have been improvements in cancer care, treatment for cataracts, and in accident and emergency services.
	Any changes that are proposed locally will have to be fully consulted on, and the decisions will be taken locally by those who are responsible for the local health service. That is the sensible way to proceed. This Government have put enormous investment into our national health service and it is important that the right decisions on its future are taken locally.

David Cameron: There we have it: no buts, just cuts.
	I join the Prime Minister in sending our condolences to the families of those soldiers who have given their lives in Iraq and Afghanistan over the past few months. We must make sure that they did not die in vain.
	The Home Office has explained that it is moving prisoners at risk of escaping to open prisons. The Home Secretary is apparently happy with that.  [Interruption.] Is the Prime Minister?

Tony Blair: As the Home Secretary has just pointed out, absconding is at its lowest for 10 years, so the idea that we are going to put the public at risk is absurd. No people will be put in open prisons who are a risk to the public.  [Interruption.] As the Home Secretary has just pointed out, the figures on absconding are the lowest for 10 years. Let me point something else out to the right hon. Gentleman. When he was advising the Home Secretary at the Home Office under the previous Administration, many, many category A prisoners as well as other category prisoners escaped. I am pleased to say that under this Administration there have been no category A escapes.

David Cameron: But the public are at risk and the Home Secretary knows it. I have a memo from the governor of Ford open prison that could not be clearer. It states that
	this will mean almost inevitably that the abscond rate
	that is, people escaping
	will go up in Cat D prisons
	and that
	medium term burglars and robbers
	are
	likely to abscond.
	Whatever happened to tough on crime?

Tony Blair: rose

David Cameron: Hold on a minute. I know the Prime Minister has only a few more goes. Let us look at something else that he said. He said that any foreign national convicted of an imprisonable offence should be deported automatically. The Home Secretary is now bribing prisoners with up to 2,500 to get them to go home. Whatever happened to automatic deportation?

Tony Blair: The Home Secretary is, very sensibly, making sure that we can ensure that all those foreign secretaries [Laughter.] There is not much of a recovery after that one. He is making sure that all those foreign prisoners can be returned as early as possible. It will obviously cost money, but in order to ensure that it happens more quickly we are making sure not that they are given a cash paymentthat is absolutely wrongbut that we pay for their return before their sentence is completed, so that we reduce the pressure on British prisons and so that, when their sentence is completed, prisoners are returned immediately. That is the only way we will get the foreign prisoners back quickly.

David Cameron: Let us look at what happened. Of the 1,000 prisoners who were released and who should have been deported, only 86 have been sent home. That is not automatic deportation.
	Let us look at another thing the Government said. The Secretary of State for Health told us that this was the best year ever for the NHS. Will the Prime Minister confirm that, since then, 20,000 jobs are being cut, 80 community hospitals are under threat and 60 major hospitals face cutbacks? Would he describe it as the best ever year for the NHS?

Tony Blair: I am delighted that we have got on to the national health service. There are not 20,000 jobs going in the national health service. Since the Government came to power, there are 250,000 extra people employed in the national health service. Let me point out to the right hon. Gentleman, since he is launching a campaign on Saturday about cuts in the national health service, that his policy proposal earlier this week was for an independent commissioning board that would apparently be free to commission all services.  [Interruption.] Nobody on the Government Front Bench is in favour of an independent commissioning board. It would be free to commission all services, and we know from the right hon. Member for West Dorset (Mr. Letwin) that there would be no limits to independent commissioning. Therefore, under the right hon. Gentleman's proposal, if the board wished to commission maternity services, paediatric services or diagnostics from the private sector, it would be able to do so without limit. How does he put forward that policy proposal on the Monday, and then launch a campaign asking me to intervene in local decisions and provide more money at the end of the week?

David Cameron: I do not know why the Prime Minister is attacking our health policy. One of his Health Ministers has said it is worth looking at and the Chancellor is going around briefing everyone that he would introduce it. I know that the Prime Minister and the Chancellor do not talk any more, but if he read the newspapers he might find out what his Chancellor thinks. The Prime Minister is living in a fantasy world. In the real world, community hospitals are closing, nurses are facing the sack and beds are being lost. No wonder Labour is not trusted any more with the NHS.
	Let us look at something else that the Prime Minister told us. He told us in JanuaryLabour Members will enjoy this one
	I'm absolutely happy that Gordon will be my successor. He needs the confidence of knowing he will succeed me and that's fair enough.
	Does the Prime Minister still think that today?

Tony Blair: Let me just say [Interruption.] I do not resile from anything that I have said, but let me just go back for a moment to the NHS. The right hon. Gentleman has just proposed a campaign, saying that he would reverse all those decisions that are being taken by local decision makers on the NHS. Let me read to him from his campaign document

Mr. Speaker: Order. The Prime Minister has gone on too much about the Conservative party's campaign document.  [Interruption.] Order. I have given the Prime Minister and the Leader of the Opposition some elbow room, and I ask both to take my advice, or sooner or later it will be my instruction.

Tony Blair: I am delighted to say why

Hon. Members: Order.

Mr. Speaker: Order. I know how to chair the proceedings. Let the Prime Minister speak.

Tony Blair: I am simply explaining why I will not accept the policy on the NHS proposed by the Conservative party. I assume that the right hon. Gentleman is launching this policy proposal because he wants us to accept it, and the reason I will not accept it is that his proposal is for an independent board to take all commissioning decisions and to allocate resources. That would mean no accountability for politicians in this House about the decisions that are taken, and it would mean that, since there are no limits to the private sector involvement, none of these services that he will protest about at the end of the week will be guaranteed under his proposals made at the beginning of the week.

David Cameron: It was a pretty straight sort of question, and the Prime Minister has told us that he is a pretty straight sort of a guy. Does he back the Chancellor as his successor? Yes or no? I do, does he?

Tony Blair: I am sure that the right hon. Gentleman is a lot happier talking about that than he is about policy, but I will talk about policy. I will talk about the policy on the NHS, our policy and his policy, because in the end the issue for the country is who has the right policies for the future, and it is the Labour party that has made record investment in the NHS, which he voted against. It is this party that has delivered better waiting times, improved cardiac and cancer care and accident and emergency departments, and his policies would put all of that at risk, and that is why we will stick with our policies,not his.

David Cameron: Everyone can see that the Government are divided and paralysed. We have a Prime Minister who does not trust his Chancellor, a Chancellor who has been accused of blackmail, the latest Home Secretary wants the Prime Minister's job, the Deputy Prime Minister does not have a job but is still being paid, and all the while hospital wards are closing and the prison system is in chaos. How many more months of this paralysis have we got to put up with?

Tony Blair: There is no paralysis. We have record investment in the health service, which is delivering the results that we say. The reason it is important that we resist the right hon. Gentleman's campaign against the cuts is that the changes that we are making in the NHS are necessary to make it fit for the modern age, when it is changing rapidly, when new technologies and treatments are coming in, and when 70 per cent. of cases are now day-care cases. He can make all the remarks that he wants, but it is this Government, on welfare, on pensions, on energy, on the NHS, on education, who are driving forwards, while his party has a series of policies that face both ways and have no credibility whatever. If he wants to be taken seriously as a leader he should get serious on substance.

Jessica Morden: Last week the Government confirmed that paid maternity leave will be increased from six to nine months from April next year, making a huge difference to the lives of about 400,000 women a year and many expectant mums in my constituency. Given that I will not be able to hang on that long, will my right hon. Friend consider putting in a good word with the Chief Whip for me?

Tony Blair: That is an interesting suggestion. First, I offer my congratulations to my hon. Friend and hope that all goes well for her piece of individual delivery. Over the past few years, we have improved maternity pay and maternity leave, we have introduced paternity pay, we have expanded child care places by about 1 million, we have given free nursery education for three and four-year-olds, and we will expand that still further, we have given the right to flexible working for the first time, and we are ensuring that in maternity pay and maternity leave we are prepared to go even further. That is the difference between a Government who deliver on policy and one who do not.

Menzies Campbell: I join the Prime Minister in his expressions of sympathy and condolence to those who have lost their lives since the House last met. We should never forget that each and every one of them leaves behind a grieving family and friends, and we should not forget the thousands of Iraqi and Afghan civilians who have also lost their lives.
	Turning to Northern Ireland, with which the Prime Minister will be engaged later today and for which he has the support of the vast majority in the House, will the right hon. Gentleman confirm that the Government are still committed to the Shared Future agenda, which the Government published in March this year and which advocates integration, not separation, for the Northern Ireland community?

Tony Blair: I certainly can confirm that. The Shared Future agenda is essential for the people of Northern Ireland, and we published an action plan to achieve it earlier this year. Obviously, what is necessary now is to get political stability within the right political framework for the future, and we hope that we can do that.

Menzies Campbell: The Prime Minister knows that the 24 November deadline is only some six weeks away. In the past, deadlines have come and gone. What is different about this deadline? And if it is not met, what will the Government do?

Tony Blair: It is a few hours before the talks begin, and it would probably not be sensible to speculate about what will happen if they do not work. It is important to recognise that this deadline is not merely a deadline in legislation. If we are to make progress in Northern Ireland, it is necessary to realise that the issues will not changethe issues have been there all the way through. We have not had a power-sharing Executive in Northern Ireland over the past few yearssince 2002because we have been unable to resolve the outstanding issues, which will not change or go away and which will still be there, irrespective of what happens. In my view, this is a one-off opportunity to build on all the progress that has been made and put in place a future for the people of Northern Ireland that will last, that will allow prosperity, that will allow people to celebrate the diversity of Northern Ireland and that will allow people to pursue their political objectives in a peaceful way. I think that that is an historic opportunity, and we should seize it.

Russell Brown: Last month, the hon. Member for Gainsborough (Mr. Leigh) and I visited the Democratic Republic of the Congo, where we saw the excellent work being done by the charity War Child for street children and child soldiers. Today, Amnesty International has expressed grave concern about the number of child soldiers still being held by warlords. Will the Prime Minister guarantee that the Government will put pressure on the new Government in the DRC to take immediate action to get those child soldiers released from the hands of the warlords?

Tony Blair: That is a problem in the Congo, and it is a problem in other parts of Africa, too. We have a clear position: we put maximum pressure on any governmental or non-governmental bodies that engage in a form of child slavery and oppression that is truly disgusting. I assure my hon. Friend that we will continue to do everything that we can to eradicate it in the Congo and elsewhere.

Daniel Kawczynski: In a major land-swap deal, Shrewsbury and Atcham borough council wants to build a museum on the site of Charles Darwin's birth and recreational facilities on land near Shelton hospital. Both sites are owned by the Government, and the council has unfortunately experienced a lot of red tape in purchasing the land. Will the Prime Minister use his good offices to help the council secure the land, rather than making it proceed through a compulsory purchase order, which would cost Shrewsbury's taxpayers more money?

Tony Blair: I am happy to look into the matter for the hon. Gentleman, and I hope that he makes a speedy recovery. I know a little bit about the issue, and I am sure that it is worth while, but I need to check whether it is possible to intervene in a helpful way. I will get in touch with him as soon as I can.

Nick Palmer: Dame Pauline Neville-Jones, the former chairman of the Joint Intelligence Committee, said this month:
	There is a growing issue that it is too easy to steal someone's identity, and ID cards are one of the ways of addressing the issue.
	Does my right hon. Friend agree with her, or does he feel that we should not try to identify criminals but understand them better, and perhaps give them a hug?

Tony Blair: What Dame Pauline Neville-Jones says is very sensible, and is yet another example of the Conservatives' policy of facing both ways, as she chairs their security commission. The reasons why identity cards are important are simple: 70 per cent. of the cost will be necessary for the new passports in any event; identity fraud and abuse is a major question; and apart from the benefits for the individual in having secure identity, it is impossible to say that we are serious about tracking who is in and entitled to be in this country and who goes out unless there is such an identity system. Therefore, anyone who is serious about dealing with illegal immigration must get serious on the subject of identity cards.

James Clappison: Will the Prime Minister give serious consideration to the petition delivered to Downing street last month on behalf of the residents of Potters Bar protesting at the closure of one third of the beds at Potters Bar hospital, a modern, purpose-built community hospital that only opened in 1995? Will he consider that issue affecting an excellent community hospital?

Tony Blair: Yes, but as the hon. Gentleman will know, the reason being put forward for the changes is not that they will diminish community facilities but that they will provide them in a different way [Interruption.] I am sorry, but that is a change going on throughout the health service for perfectly good reasons. His petition to me, of which I have read the reports, makes the point about the differential in funding between different parts of the country. It is true, for example, since he has said it in his local newspaper, that there is a 20 per cent. gap between the funding per head in his constituency and that in my constituency, but that is based on the figures for mortality though cancer, mortality through coronary disease and low birth weight. Actually, it is
	the fact that the most NHS resources should be given to those areas where the disease burden is highest.
	That is a quote from the Conservative campaign document.

Diana Johnson: Given the latest obesity figures, will my right hon. Friend join me in congratulating the Labour councillors in Hull who introduced the Eat Well, Do Well scheme, which has doubled the uptake of healthy free school meals in Hull?

Tony Blair: I am delighted to congratulate them, and I am sure that it is an important part of the public health drive in Hull and elsewhere in the country. The reason it is important is that, as we extend community facilities, as we see changes in school dinners and in competitive sport in schoolswhich has increased to 80 per cent. from the 50 per cent. that we inheritedand as we are able to provide greater local community services in which public health is a major part, the general health of the nation will be improved, which will reduce the long-term costs in our health care system.

Stewart Jackson: On 29 April this year, on behalf of my constituents, on an issue of major importance, I asked the Home Office a simple question: how many foreign prisoners had been released from Peterborough prison in the previous 12 months? Five months on, I have yet to receive a satisfactory reply. Having once described himself, with his customary humility, as a pretty straight kind of a guy, why is it impossible to get a straight answer to a straight question from this Prime Minister and his Government?

Tony Blair: Obviously, I do not know the figures in respect of Peterborough, and I will have to look into that and reply to the hon. Gentleman. Let me make one thing clear. In removing foreign prisoners, in relation to which, in certain instances, there are difficulties in the courts and elsewhere, we are keeping figures on foreign prisoners for the first time in years. Under the previous Government, no such figures were kept at all.

Ben Chapman: I join in the House's welcome for the package of measures announced by the Secretary of State to support our troops serving bravely in the difficult theatres of Iraq, Afghanistan and the Balkans, but will my right hon. Friend think more widely about what further measures of support can be given to our troops serving overseas? Is it right, for example, that people serving valiantly in other countries should be asked to pay council tax in this country?

Tony Blair: I thank my hon. Friend for his welcome for the measures that were announced yesterday, including the important tax-free bonus of more than 2,000 for completing a six-month operational tour. The separation allowance announcement is also important. In addition, we are considering other issues, one of which is the council tax, which he mentioned. The Ministry of Defence is discussing that with the Department for Communities and Local Government. There is another specific issue involving soldiers from Commonwealth countries who fight for our armed forces, but have difficulties with naturalisation because of residence requirements. That is something that we want to look at as a matter of urgency and I hope that we can announce changes in the next few weeks.

Stephen Crabb: Two businesses alone in Pembrokeshire contribute some 200 million to the Exchequer between them in tax every single month. Given the enormous sums now being raised in tax from companies and householders in Pembrokeshire, will the Prime Minister please explain to local people why their NHS dentists have disappeared, why their last full-time fire station is being downgraded, and why the excellent Withybush hospital in Haverfordwest is being earmarked for closure? It is an appalling record of public service cuts.

Tony Blair: I shall just point out where the money has gone in the hon. Gentleman's area. It has gone on 400 more consultants, 7,500 more nurses, and 100 more dentists. In education, there are 1,700 more teachers and 5,700 more support staff. Class sizes are also at historically low levels. The hon. Gentleman might also want to know that unemployment is at a historic low, interest rates are at a historic low, inflation is at a historic low and the economy is the strongest it has ever been.

Louise Ellman: Will my right hon. Friend take a personal interest in the negotiations taking place between the Bulgarian authorities and the UK authorities on the transfer of Michael Shields from a Bulgarian jail to the UK? What qualities does my right hon. Friend believe Bulgaria would bring to an enlarged European Union?

Tony Blair: It is important that we continue with the enlargement process, because it helps countries to make political and economic progress. I understand my hon. Friend's concern about the individual case and I know that she has raised it with me before. We will continue to raise it with the Bulgarian authorities, but we have to be careful about interfering with another country's independent judicial process. I can assure her that we will monitor the case closely and we are in touch with the Bulgarian authorities about it.

Adrian Sanders: When the Prime Minister wrote to his Secretaries of State on 19 May, setting out key challenges ahead, why did he not mention tourismone of the country's main industriesin his letter to the Secretary of State for Culture, Media and Sport?

Tony Blair: Tourism is of course a vital priority, not only for the Department for Culture, Media and Sport, but for the Department of Trade and Industry. I am pleased to say that we are improving the quality of tourism all the timeespecially as a result of the investment in skillsand attracting more and more people to places in this country such as his constituency, for good reason. We will continue to do everything we can to support our tourist industry.

Betty Williams: My right hon. Friend will be aware of the strength of feeling on both sides of the House about climate change. I have written to him recently on behalf of many constituents to request the introduction of a climate change Bill. Am I likely to be satisfied and happy with the reply when I receive it from my right hon. Friend?

Tony Blair: Nothing would please me more than to make my hon. Friend happy and satisfied, but we will have to wait for the Queen's Speech and the outline of the Bills it contains. However, my hon. Friend is right to emphasise the priority that we attach to the climate change issue. It is why we introduced the climate change levy, which is saving millions of tonnes of carbon a year, and it is why it is important that we work with the EU and other countries. Last week in Mexico we made real progress on a framework for when the Kyoto protocol expires in 2012. It is also why we announced recently a five-fold increase in renewable energies. An immense amount is happening here and I assure my hon. Friend that we will continue to take the issue very seriously, but I am afraid that she will have to wait for the Queen's Speech to see whether her satisfaction is complete.

Bob Russell: This week, soldiers from 16 Air Assault Brigade have been returned to Colchester garrision after their dangerous deployment in Afghanistan. I am sure that the House will salute their courage and send its best wishes for recovery to those who have been injured and its condolences to the families of those who lost their lives serving their countryCaptain James Phillippson, Private Damien Jackson, Captain Alex Eida, Private Andrew Cutts, Corporal Bryan Budd and Corporal Mark Wright. Will the Prime Minister confirm that UK troops are in Afghanistan to help rid the world of terrorism? If that is the case, does he share my dismay that the majority of EU and NATO countries have not deployed their troops to Helmand province?

Tony Blair: First, I join the hon. Gentleman in paying tribute to the Paras and the extraordinary work that they have done in Afghanistan. It is hard for anyone to imagine the trial that they have been through or the courage with which they have met it. It is also very clear from what is happening in Helmand province that they have been successful in pushing the Taliban back. The struggle is by no means over, but it is essential that we continue with it.
	The hon. Gentleman is also right to say that it is important that all members of NATO should play their part. However, to be fair, Canadian and American soldiers in the area are also losing their lives, and Spain, Italy, France and Germany have all lost troops there. I was with the Finnish Prime Minister last week and I can tell the hon. Gentleman that even the relatively small contingent from Finland has lost troops there.
	The situation is very difficult. We want to make sure that NATO does more, and that is what the Defence Secretary said at the meeting the other day. It is important that we all make it clear why our troops are in Afghanistan. The country was used as a training ground for al-Qaeda. It was from there that terrorism was exported and the 11 September attacksin which more British lives were lost than in any other terrorist incidentwere launched. If we allow Helmand province or any other parts of Afghanistan to return to the grip of the Taliban and al-Qaeda, they will yet again become a training ground for terrorism. That is why the work that our Paras did was not only immensely brave but immensely necessary.
	Sometimes it is important that we do not merely support our troops in the obvious way by saluting their courage, but that we also have pride in the success of the work that they are doing. It is absolutely vital, for our security and for that of the whole world. We should be extremely grateful that we have men and women in our armed forces who are prepared to risk their lives and make that sacrifice.

Scrambler Bikes (Licensing)

Chris Bryant: I beg to move,
	That leave be given to bring in a Bill to require scrambler bikes to be licensed; and for connected purposes.

Mr. Speaker: Order. Will hon. Members please leave the Chamber quietly?

Chris Bryant: I do not know whether you, Mr. Speaker, have ever ridden a motorbike. The closest that I ever got was when I hired a Vespa on holiday in Greece. I think that I was the only person in that country to wear a helmet, and I certainly rode considerably more slowly than any Greek person dideven the octogenarian grandmothers carrying 15 chickens on the back of their bikes. However, I know that many bikers derive enormous pleasure from their motorbikes. They describe the sense of excitement and the adrenalin rush in almost ecstatic terms, saying that only a biker truly knows why a dog sticks its head out of a car window.
	I want to do nothing to undermine bikers' sense of enjoyment and excitement, least of all in the Rhondda and the valleys. I know that many bikers come to the valleys because it is an enormously exciting and pleasurable place to go biking. For example, one can go over the Bwlch into the constituency of my hon. Friend the Member for Ogmore (Huw Irranca-Davies), or over the Rhigos, or over into Llanwonnowherever one goes, there are beautiful places for biking. It is easier if one is on a motorbike rather than a pedal bike, as I know to my cost.
	Part of the thrill of biking is the sense of danger that is attached to it. It is true that in this country two-wheel drivers are 40 times more likely to suffer a serious injury or to die than four-wheel drivers. Some 585 motorcyclists were killed and 6,063 were seriously injured in road accidents in 2004. Motorcyclists represent only 1 per cent. of the traffic in the UK, but 19 per cent. of the deaths and serious injuries. The more we can do to enhance safety and to make sure, for instance, that drivers in their cars look out for motorbikes when they turn on to a main road, the better.
	However, my Bill has nothing to do with those licensed road users. It is about the thousands of unlicensed vehicles, many of them supposedly designed to be ridden off-road. The problem is pretty simple. The law makes it clear that if a bike is driven on the road, it must be registered with the Driver and Vehicle Licensing Agency, taxed and insured, and have a standard number plate, proper brakes, audible warning instruments, brake lights and indicators. The exhaust must also conform andthis is importantmust not be too loud or altered in any way. In addition, the law states that the rider must hold a driving licence for that class of vehicle and must wear an approved protective helmet. Furthermore, if the bike is used at night, it must comply with lighting regulations and have lights fitted and working.
	I am sure that all Members would agree that all that is fine and dandy, but, by definition, it applies only to vehicles designed for use on the road, when they are on the road. There is a whole other category of bikes that are not licensed because they are, in theory, designed to be used only off-road. That is where the problem begins. Every evening and every weekend in the Rhondda there are literally thousands of unlicensed, uninsured scrambler and mini-motorbikes on the road. I suspect that the Rhondda is not unique in that and that all hon. Members have experience of that phenomenon.
	In theory, those bikes are only to be used on private land. In practice, they are driven over public land, bridleways and paths, private land without permission and, notably, on the road. Often, they are unsafe vehicles with poor tread and unreliable brakes because they do not have to go through an MOT. Often, they are driven by childrennot only under the legal age, but sometimes as young as eight, nine, 10 and 11. Often, they are driven recklessly and dangerously, and as they are often driven by children, it is difficult to expect more. Often, they ruin areas of natural beauty, digging up beautiful areas of the countryside. Often, they are fitted with so-called silencers, which actually make the vehicles louder rather than quietersomething that the industry must work on. In every instance, by definition, they are not insured, so when there is an accident, the innocent party often not only has the problem of the crash, but has to face increased insurance premiums later in the year.
	For people in the Rhondda, that means a deafening racket reverberating around the valleys nearly every evening and every weekend. It means that pavements and roadsespecially, for some bizarre reason in cul-de-sacsbecome virtual race tracks. All too often, it means that a 10 or 11-year-old is put in charge of a lethal weapon that can go up to 60 mph. I believe that that is simply wrong. One person e-mailed me yesterday to say:
	In Aberavon on the beach we suffer continually with damage to the dunes and nature areas from motor bike enthusiasts driving at speed over the beach and in the dunes every day.
	The situation is getting worse. According to Revenue and Customs, there has been a twentyfold increase in the number of Chinese-imported mini-motorcycles coming into the UK. The number rocketed from 7,000 in 2001 to 144,000 in 2005, the last year for which figures are available. No wonder that, in Reading, 44 per cent. of all calls to the council's antisocial behaviour hotline are to do with mini-motorbikes and the noise that they create. No wonder that Kent police received 4,000 calls about them last year alone. No wonder people complain about the problem at every single PACT meeting in the Rhondda, or that my local chief superintendent, Jeff Farrar, says:
	the menace of scrambler motor bikes is the biggest single issue ruining people's lives in the Valleys.
	The police have tried all sorts of things. They have tried stopping all the vehicles at the areas where they regularly congregate and arresting the riders in one fell swoop. They have tried providing information about what is legal and illegal. They have tried using new on-the-spot fines legislation, which has been successful, and impounding vehicles. However, their biggest difficulty is that they are hamstrung when they see someone driving a bike illegally. They cannot give chase, because if they did and a youngster came off the bike and was injured, it would be quite likely that the police officer involved would be suspended pending an investigation. Additionally, such a chase would of course be dangerous to the general public.
	The main problem is that the police cannot identify the bikes because they do not have licence plates. That is why I believe that we should license all bikes, regardless of whether they are designed to be driven on the road. The relevant legislation is section 1(1) of the Vehicle Excise and Registration Act 1994, which says:
	A duty of excise...shall be charged in respect of every mechanically propelled vehicle which is used, or kept, on a public road in the United Kingdom and shall be paid on a licence to be taken out by the person keeping the vehicle.
	The provision should be amended so that it covers not just on-road vehicles, but all off-road vehicles.
	Who supports the proposal? The British Motorcyclists' Federation does, with its 130,000 members, as does the Trail Riders Fellowship. The Greater Manchester police authority supports itI am sure that many hon. Members' police authorities doand has been calling for such a scheme for a while, as has my hon. Friend the Member for Telford (David Wright), not least because a friend of his was knocked down on a piece of open land by an unlicensed, unidentifiable bike that drove off. The fact that the bike had no number plate meant that it could not be tracked and justice has thus not been done. Licensing is not the only thing that we should do. I have mentioned the noisy silencers, and it must be time that either the industry acts to make biking quiet, or the Government take action to ensure that everyone can enjoy their right to a peaceful existence.
	We must accept that many local authorities have been slow to make proper legal provision for bikers. As one constituent wrote today:
	if proper motor cross tracks are made this will stop 90 per cent. of people riding where they shouldn't
	I agree. Proper, well-designed tracks in areas where noise will not impinge on the local population are vital if we are to win the battle. Biking is a great sportI am sure that my right hon. Friend the chairman of the party agreesbut the illegal use of scrambler and mini-motorcycles is bringing biking into disrepute. It is time that we abolished the false distinction in law between on-road and supposedly off-road biking.
	 Question put and agreed to.
	Bill ordered to be brought in by Chris Bryant, Jessica Morden, Philip Davies, Anne Snelgrove, Ms Barbara Keeley, Rosie Cooper, Mrs. Madeleine Moon, David Wright, Mr. Iain Wright and Mr. Tom Watson.

Scrambler Bikes (Licensing)

Chris Bryant accordingly presented a Bill to require scrambler bikes to be licensed; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 20 October, and to be printed [Bill 223].

Opposition Day
	  
	[18th Allotted Day]

NHS Workforce and Service Development

Mr. Speaker: We now come to the main business: the 18th allotted Opposition day, which is a debate on NHS work force and service development. I inform the House that I have selected the amendment in the name of the Prime Minister.

Andrew Lansley: I beg to move,
	That this House, while welcoming past increases in the number of doctors, nurses and other health professionals working in the NHS, is alarmed at the recent reports of up to 20,000 posts to be lost in NHS hospitals and cuts in training budgets; is deeply concerned about the lack of training posts for junior doctors; condemns the severe shortage of posts for nurses and physiotherapists leaving training; regrets the complete failure of the Government to remedy flaws in the implementation of the European Working Time Directive in its application to doctors' hours; further regrets the unemployment of specialist medical staff; believes NHS services are being cut back as a result of both financial deficits and staffing shortages rather than in the interests of patient safety; and calls on the Government to ensure that the NHS fully utilises the potential of healthcare professionals available to the service.
	The purpose of this debate is straightforward. The NHS is, in a real sense, its staff. The number and quality of health care professionals in the NHS is key to the quality of health care provided, and I am sure that Members on both sides of the House share a deep gratitude to doctors, nurses, therapists, scientists and health care professionals of all types across the NHS for their tremendous work. Improving the number of NHS staff is central to improving services.
	Under the Conservative Government, the number of doctors increased by 23,000 and the number of nurses by 55,000. Under the present Government, according to the work force census, there are 33,368 more doctors, contrary to what the Government amendment says. There are 85,305 more qualified nurses and midwives than in 1997. The number of administrators has, of course, increased by 107,000. Under Labour, not only have the resources been badly usedaccording to the Office for National Statistics, productivity has fallen by 1 per cent. a year during the life of this Governmentbut now deficits are hitting those very staff. We know, and have debated, the scale of the deficitstoday's debate is not primarily about that subjectand the Secretary of State has had to admit not only that the deficit last year was 1.3 billion gross, but that it was higher than she had previously estimated. It is now 547 million net.
	Those deficits across the country are directly impacting on services. Decisions being made for short-term financial expediency have a direct impact on those staff. It is on that issue that we want to focus todaythe impact on the staff of the NHS and, by extension, on the services that they provide, of the mismanagement of finances across the NHS.

Bob Blizzard: There is one Opposition policy of which we are awaretheir wish, as they say, to share the proceeds of growth between investment in public services and tax cuts. Can the hon. Gentleman tell us how much money will be removed from the NHS budget as a result?

Andrew Lansley: The answer is straightforward: no money would be removed from the NHS. On the contrary, what my right hon. and hon. Friends have said means that the NHS will be able to participate in the enhanced economic growth that will be the product of our economic policies, and so can deliver more resources for the NHS in the future. I know that it depresses Labour Members that the Leader of the Opposition has frequently said that he will give priority to the NHS and has expressed his determination not only to increase its resources but to give it freedom from day-to-day political interference. We have said all of those things, and the public agree with them. The hon. Gentleman has to understand that we are putting that forward not on the basis of political advantage, but because it is in the interests of the national health service.

Sadiq Khan: Can the hon. Gentleman confirm that, despite all the cuts that he claims will be made, staff will be safe and no jobs will be lost under a Conservative Government?

Andrew Lansley: I am interested in what the hon. Gentleman says. He will forgive me if I am wrong, but I think that his local hospital is part of the Mid Yorkshire Hospitals NHS Trust. Is that right? [Hon. Members: Tooting.] I beg his pardon. I will give way to him again if he cares to tell us how he thinks that the deficits at St. George's hospital, Tooting, will be resolved other than by giving the NHS, including hospitals such as St. George's, much greater freedom to enable them to use resources more effectively. Frankly, under this Government, that is not happening. Hospitals such as St. George's are living under a regime of regulation and control, and the financial imposition of costs by the Secretary of State is causing them enormous damage. Perhaps he can comment on the fact that the Government admit that a 25 per cent. increase in the cost of hospital services in the past three years has eaten up all the money that has been provided to hospitals such as his.

Sadiq Khan: The hon. Gentleman mentioned money at St. George's. He will be aware of our new walk-in centre and our new Atkinson Morley wing, which is preventing deaths by cancer, and he will also be aware that we have doubled the number of nurses in the past nine years and have 500 more doctors. Can he now answer my question? Will all the staff that might be cut throughout the country because of the devolved powers of their trusts be saved by a Conservative Government?

Andrew Lansley: I cannot, of course, make that promise. How could I make it? If the Secretary of State and the Government would care to call an election tomorrow and disappear[ Interruption.]

Mr. Speaker: Order. The House must calm down and allow the hon. Gentleman to develop his case.

Andrew Lansley: If the Labour party would vacate the Government Benches and give us the opportunity to take up the responsibilities of government, we would ensure that NHS resources are used more effectively to deliver services for patients, that the staff the NHS recruit are front-line staff who deliver those services for patients, that accessible serviceswhich are demanded by patients and GPscan be commissioned by GPs on their patients' behalf, and that the threat that is the consequence of the Government's policies is lifted. Unfortunately, I cannot promise that, because the Government are not going to disappear tomorrow and the hon. Member for Tooting (Mr. Khan) is asking me about jobs that are under threat now. I cannot promise that I can restore those jobsof course I cannot. But I can promise that we will have policies that never lead, through gross mismanagement, to the problems that we face today and for which the current Government are responsible.
	Let me tell the House how many jobs we are talking about: 20,000. I heard what the Prime Minister said; he had the effrontery to stand up at the Dispatch Box at Prime Minister's questions and say that there is no such threat of 20,000 job losses. He might like to look at some information I have, namely, that 64 NHS trusts have announced up to 20,000 posts that will be cut in the hospital sector alone. If the Prime Minister tries to deny that, let me refer him to the NHS Confederation, which is in no mood simply to support my party on this matter. It wants to minimise the effect of what might happen and it has issued a briefing. Labour Members seem to be reading only from the Labour Whip crib sheet, when what they should be doing is reading the briefings they have been receiving from organisations that know something about this matter.  [Interruption.]

Mr. Speaker: Order. Ms. McIsaac, I have already asked for some calmness in the Chamber and you are not helping me. You are not being as helpful as you usually are in such situations.

Michael Penning: There is a lot of laughter on the Labour Benches, but there is not much laughter in my constituency, where 750 doctors, nurses and key medical workers are being sacked by this Government.

Andrew Lansley: I understand exactly what my hon. Friend says. When the casualties of the Buncefield oil depot incidenthappily, there were very fewwere taken to an accident and emergency department, it was the one at my hon. Friend's Hemel Hempstead hospital, and that accident and emergency department could have shut under this Government. Labour Members might like to explain why such things are happening. Indeed, they might like to explain

Geraldine Smith: Will the hon. Gentleman give way?

Andrew Lansley: I will in a moment, but to my hon. Friend the Member for Christchurch (Mr. Chope).
	Labour Members might like to explain why the Prime Minister gets up and issues a denial in this, when the NHS Confederation says:
	The figures being widely quoted of up to 20,000 may turn out to not be too far off the total reduction in workforce numbers this year.
	In fact, what the NHS Confederation is saying is worse than I thought because it is talking about an overall reduction of 20,000, whereas I am talking only about an announced 20,000 posts to be cut in the hospital sector. One might have imagined that there would be at least some compensating increase in posts in the community sector, but that is not, apparently, the experience of the NHS Confederation.

Christopher Chope: I am grateful to my hon. Friend for giving way. He is making some excellent points [Laughter.]

Mr. Speaker: Order.

Christopher Chope: When I attend the Conservative NHS action day stalls in Christchurch on Saturday, I know that I am likely to be asked what our policy is in response to the National Institute for Health and Clinical Excellence decision to deprive those in the early stages of Alzheimer's of much needed medication. Can my hon. Friend assure me that we will overrule that decision by NICE when we get into government?

Andrew Lansley: I am happy to be able to agree with my hon. Friend's first sentiment, but on Alzheimer's drugs I cannot give him the assurance for which he asks.  [Interruption.]

Mr. Speaker: Order, this behaviour certainly will not help the debate. Those who are listening to our proceedings will wonder why we are behaving in this way in a debate on such an important issue. I know that there is some excitement around, but things are getting to a stage where we are having a bawling or shouting match. Labour Members should understand that the Secretary of State's turn to speak will come, and I will seek the same courtesies for her as I seek for the spokesman for the Opposition. I know that the Speaker should not intervene for so long, but the Chamber is getting far too noisyand perhaps one Member will be disciplined if we continue in this way.

Andrew Lansley: Thank you very much, Mr. Speaker.
	I was endeavouring to explain something to my hon. Friend the Member for Christchurch, with which he may or may not agree. NICE has to do an exhaustive job of trying to assess whether it is in the interests of the NHS that a treatment be provided because it is both clinically effective and cost-effective. That process has been extremely useful because it has increasingly exposed what is cost-effective and clinically effective about Alzheimer's drugs. They are effective for patients, especially for those with moderate and severe Alzheimer'sdementia. However, in respect of mild dementia, they are not regarded as sufficiently effective to be a treatment that should be recommended on the NHS. Frankly, it is my opinion that in an independent national health service such decisions must be made independently and we must ensure that there is a correct statutory framework. On this matter, one important issue remains in my mind. Because of the nature of the regulations prescribed by the Government, the benefits that NICE can take into account apply only to the national health service and to publicly funded social care. The benefits to carers and their families beyond that point cannot be taken into account. We must look into thatand that might, of course, have a bearing on the outcome of any appraisal undertaken by NICE.

Jonathan Djanogly: As my hon. Friend knows, hundreds of jobs have gone at Hinchingbrooke hospital, with hundreds more likely to go, and the hospital is now subject to a closure threat. It seems to me that the strategic health authority's review is in fact cover for a slash-and-burn policy conducted by this Government. What does my hon. Friend have to say about that?

Andrew Lansley: To some extent, my hon. Friend and I share that hospital. Patients from my constituency go to Hinchingbrooke hospital. That anticipates something that I was going to say. It is disgraceful that reviewsin inverted commasshould be taking place that are in fact driven by finance. The implication [Interruption.] Members might like to listen to this point. The implication of that for staff working at Hinchingbrooke is that the maternity unit has to be closed because it is not safe, but that is not true as it has one of the finest patient safety records in the country. That is financially driven.
	Frankly, I do not think that the strategic health authority should be the body doing that. We are supposed to be movingthis is what the Government saytowards a structure in the health service that is increasingly geared towards the decisions of local commissioners such as primary care trusts, practices through practice-based commissioning, and patient choice. However, on the contrary, we have a strategic health authority that has just been established and that has inherited a financial problemmany of my colleagues right across the east of England are in the same position. Because of a 233 million deficit, it will decide which hospitals stay open and which are shut. That is a disgrace. In a year or two services will be shut down by the strategic health authority, but in subsequent years we will have to re-establish them because they are required to meet the needs of patients.

Kevin Barron: May I ask the hon. Gentleman about a news story that I read on the Conservative party website? Does he agree with the Leader of the Opposition when he says that
	the NHS matters too much to be treated like a political football?

Andrew Lansley: Absolutely, and that is exactly why my right hon. Friend and I explained on Monday how we could take politicians out of the day-to-day management of the NHS. However, as we heard from the Prime Minister at lunchtime, he is so keen on having the NHS as a political football that he is not prepared to allow it greater independence. I am sure that when the time comes, the Chairman of the Health Committee will want to ask the Secretary of State what the NHS political football game looked like on 3 July, when she sat down with the chairman of the Labour party, Ministers and political advisers, including Labour party staff, in order to debate their heat maps and to decide where in the country hospitals were to be shut. Frankly, that is not acceptable. It is the Government who are indulging in that political football game, not us.

Several hon. Members: rose

Andrew Lansley: I will carry on for a minute. I have taken an intervention and I have yet to get on to the issues that we really need to reach.
	We need to understand that all the deficits are having major consequences for staff. As I said, we might have imagined that, at the same time as jobs in hospitals were being cut, they were being created in the community. Members will recall that back in January, a White Paper was published the purpose of which was to state that precisely that shift of patients would happen. Well, what do we find? The work force census showed that in the last year for which figures were available, there were 485 fewer health visitors, 760 fewer district nurses, and even 36 fewer midwives. Yet the Government seem to think that those people are somehow magically going to increase in number and be available to provide services.
	The Prime Minister made a speech on this issue last month. The action plan for social exclusion says that all additional health visitors and community midwives will be upskilled in order to undertake early interventions with families. Health visitors in my constituency used to visit every family, but that service disappeared about seven years ago. There simply is not the number of health visitors to enable that to happen.

Graham Stuart: I am grateful to my hon. Friend for giving way. Is he aware that in the first six months of this yearin other words, almost from the moment that the Secretary of State sat down after presenting the White Paper in this House10 community hospitals across England were closed under this Administration, with devastating effect? That is the exact reversal of the Government policy set out in that White Papera vision that many Conservative Members shared, but which has not been delivered on the ground. It is that sense of betrayalthe difference between the words and the realitythat is so undermining confidence in this Government.

Andrew Lansley: I entirely agree with my hon. Friend. Let me give an example. If the Government were serious about supporting community hospitals, they would have taken the technical step that would have helped: unbundling the tariff to enable patients to be discharged from acute hospitals and transferred to community hospitals, with the money going with them. The Government keep talking about it and saying that it will happen, but they have not done it.

Several hon. Members: rose

Andrew Lansley: I give way to the hon. Member for Dartford (Dr. Stoate).

Howard Stoate: I am most grateful to the hon. Gentleman for giving way. I cannot help thinking that we might be losing the focus of this debate. Surely what matters in the health service is patient outcomes and patient care. As I still work as a GP, I can point to the fact that it now takes only two weeks to see a cancer consultant and to the fact that waiting lists are falling and GPs are providing much more care in their own practices, thereby significantly reducing the need to refer people to secondary care. Those are significant improvements in patient care, which surely is the purpose of the health service.

Andrew Lansley: I am grateful to the hon. Gentleman. Patient care does indeed matter tremendously, and in pursuit of that, patients in his practice will no doubt find things improving when he returns to full-time work in the NHS after the next election.

Gregory Barker: Will my hon. Friend give way?

Andrew Lansley: May I just answer the hon. Member for Dartford (Dr. Stoate), because there is an important point here? In their amendment to this motion, the Government say that
	death rates from cancer and heart disease are falling faster than ever before,
	and the Prime Minister said at Prime Minister's questions that deaths from coronary heart disease had fallen since 1997. Indeed they have, but as it happens they have not fallen faster than ever before. In the seven years before 1997, the death rate for circulatory diseases and the cancer death rate fell slightly faster than in the seven years since that date. The right hon. Member for Rother Valley (Mr. Barron), the Chairman of the Health Committee, made a point earlier about the use of the health service as a political football. Well, a good starting point would be to tell the whole truth about what is going on.
	Yesterday, the Government [Interruption.] Let me finish this point. Yesterday, the Government published health profiles across England and said that cardio-vascular disease death rates have been falling since the mid-1990s. They have notin fact, they had been falling for at least a decade before that. Let us be honest about what is going on. There is a long-term secular reduction in both coronary heart disease and cancer death rates, which is very much to be welcomed. That has not happened simply as the consequence of the 1997 election, or of additional money. It has happened in virtually every developed country across the world, so let us be honest about these things.

Several hon. Members: rose

Andrew Lansley: I give way to my hon. Friend the Member for Epsom and Ewell (Chris Grayling).

Chris Grayling: I am very grateful to my hon. Friend. In my view, Labour Members simply do not understand the reality of what is going on. Two weeks ago, there were thousands of people on the streets of Epsom protesting against the loss of services at our local hospital. We now face the loss of services not only there but in Guildfordironically, given the Secretary of State's clumsy party political intervention at St. Helier before last year's local electionsand we are losing community services and district nurses. The podiatry service is now being provided by Age Concern, and it looks as though we are going to lose sexual health advice for teenagers. What is going wrong? Labour Members seem not to understand the reality of our health service today.

Andrew Lansley: Frankly, the quality of management at the top of the health service is what is going wrong, and that stems from Ministers. I hope that the Secretary of State will have the grace to apologise for trying, for political reasons, to steer a capital project to St. Helier, rather than to where the evidence pointed to. She had to backtrack on that in August.

Several hon. Members: rose

Andrew Lansley: I am going to carry on because, as the hon. Member for Dartford rightly said, we have got to get to the points that really matter. There are a lot of NHS staff out there who want to know what the Government are actually going to do now about these problems. There are junior doctors worrying about whether they will find training places. I am glad that the Government said that they are going to find between 22,000 and 23,000 places in August 2007; indeed, I raised precisely that issue with the Secretary of State back in January. Of course, and as I recall from last year's flu statistics, she has always had problems understanding what is England and what is the United Kingdom. In this instance, she has gone for 22,000 to 23,000 training posts in the UK, in order to meet a demand for 22,000 such posts in England, so the figures do not quite add up.

Chris Bryant: Will the hon. Gentleman give way?

Andrew Lansley: No; I am carrying on for a bit.
	I do hope that the Secretary of State will also make it clear that, wherever possible, such posts will be run-through training posts that give the junior doctors concerned greater assurance that they can qualify and get their certificate of completion of specialist training in due course.
	It is not only doctors who have problems. As the Royal College of Nursing made clear in its surveys, many nurses are leaving college unsure that they will find jobs; indeed, many do not find jobs. In some cases, half or more of the graduate output do not find jobs. Some 100,000 nurses are due to retire in the next five years, and over the next three years there will be a 20 per cent. reduction in the number of nursing training places. What are the prospects for nurses? I met a nurse in my surgery just last Friday, who said:
	I have just qualified as a nurse, and finished my degree in children's nursing at the beginning of July. I have been applying for jobs since May and am still unemployed...for one interview I attended, 45 candidates were being interviewed from over 120 applications. I am at a loss to know what to do.
	I also received a copy of the following letter from a lady, who writes:
	My daughter will qualify as a psychiatric nurse in August after three years of training...She and her fellow students have been informed that there will be no training posts for them in Cornwall on qualification...The situation now is that she will not have a job in the Health Service within her chosen profession. And she will not be able to find employment abroad without one year of post qualification training.
	Let us consider physiotherapists. How many Members present met members of the Chartered Society of Physiotherapy when they came here in July? Well, I met the students from the Royal London: 99 students completed the course, but only one has a job.
	A lady writes to me:
	My daughter is one of hundreds of newly qualified physiotherapists unable to get a job because of the crisis in the NHS...My local hospital has a waiting list of 10 months to see a physiotherapist.
	Somebody writes from Norwich that of 96 students leaving physiotherapy training only five found jobs. A letter from Lincolnshire states:
	Not one student from Nottingham (which is a centre of excellence for physiotherapy) has been able to find employment as a physiotherapist in the NHS. This abysmal situation appears to be directly due to the budget deficits across the NHS.
	I have a question for the Secretary of State, because a practical issue is involved. In Scotland, as she knows, the Scottish NHS guarantees nurses and physiotherapists a year of employment following their graduation. Will she say that the same thing will happen in England?

Dawn Butler: I agree that we should be honest about the debate. Part of the reason why death rates for cancer and heart disease are falling is that our Government have set targets[Hon. Members: Ah.]Yes, targets. There is faster treatment: 99 per cent. of people diagnosed with cancer receive treatment within four weeks of diagnosis. Will the hon. Gentleman tell us whether his policies will reflect that or whether their NHS plan stands for no honest solution from the Opposition?

Andrew Lansley: I am sorry that the hon. Lady was clearly not even listening to what I was saying. As yet, there is no discernible change in the trend reduction in deaths from cancer, even as a consequence of the additional investment in the NHS cancer plan. We might wish it otherwise, but that is the case. The fact that death rates continue to go down is much to be welcomed, but it has much more to do with things such as the reduction of smoking, as well as with the quality of service. When we compare our cancer death rates to those in other countries, we see that early identification of tumours will be absolutely instrumental in their further reduction. The cancer plan said that there needed to be awareness of symptoms and up-front investment for prevention, but that has not happened.

Edward Leigh: Ultimately the question is one of money and value for money. If we are to have more local control and accountability, can my hon. Friend give the House an assurance that, through Parliament's Committeesespecially the Health Committee and the Public Accounts Committeewe will still be able to follow the money? Ultimately, the House must remain responsible for all public money spent.

Andrew Lansley: I am grateful to my hon. Friend, who properly defends that important interest. Nothing we have said would deflect from it. The service would be publicly funded, where propriety and value-for-money considerations would remain the responsibility of the inspection bodies throughout the process, all the way down to the point where GPs exercise commissioning responsibilities. It needs to be so, because the service uses public money.

Several hon. Members: rose

Andrew Lansley: I do not want to take more than about half an hour, as many Members want to speak.
	Deficits do not affect only trainees; they have a direct impact on existing specialists. A report suggests that, by December, 61 cardio-thoracic surgeons will be without a consultant appointment in the NHS. I am advised that 37 ear, nose and throat specialists do not have posts at present. The Royal College of Anaesthetists tells me that whereas in previous years there have almost always been about 30 advertisements a month for new anaesthetist postslast year there were 31 in July and 29 in Augustonly 17 were advertised in July this year and only four in August. The president of the royal college rightly says that a great number of people in other countries are looking for anaesthetists. My concern is that if we make life difficult for too long, they will go; we will lose the specialists we need.
	The Government should note that the British Orthopaedic Association has already told them that the average retirement age of orthopaedic surgeons has gone down by three years over the past seven years. Such is the extent to which we are losing services.

Anne Milton: To go back to my hon. Friend's comments about physiotherapists, does he agree that with the Government's drive for more people to be looked after at home and closer to their homes, physiotherapy services, and physiotherapists, are absolutely crucial to ensure well-being and treatment, especially of an older population?

Andrew Lansley: My hon. Friend is absolutely right. The situation for stroke patients, for example, is utterly depressing. Even if they are able to secure early and intensive rehabilitation, sometimes treatment cannot be followed up to maximise their chances of recovery, owing to the lack of physiotherapists in post. We must have more physiotherapists. The Government said that we needed more physiotherapists and that there would be 60 per cent. more. People went into the profession as a result. A physiotherapist told me: I knew what was intended so I went into the course. Now there are no jobs. That is a deeply depressing fact; it is a cruel irony played on people who took up such courses.

Several hon. Members: rose

Andrew Lansley: I really should try to reach the end of my speech.

John Bercow: Will my hon. Friend be generous?

Andrew Lansley: No, I am sorry.
	Not only have we lost specialist posts but training budgets are being cut. The Secretary of State might like to tell us whether it is the case that, as reported, training budgets across the country will be cut by 10 per cent. this year. She might like to consider the example of Leicester, where the strategic health authority says that it will cut 52 million from the training budget. The University Hospitals of Leicester NHS Trust told Leicester university that it will cut clinical academic funding by 20 per cent. That will mean the loss of 15 per cent. of the medical school staff, who spend more than half their time treating patients. Some of the senior staff, who are integral to the trust's delivery of service, will be lost.
	To be fair to the Government, in 2002, they introduced the GP returner scheme and 550 GPs used it, but the money has disappeared. In 2006-07, there will be no money for the scheme; it is disappearing across the country.

Rob Marris: Will the hon. Gentleman give way?

Andrew Lansley: No.
	I want to mention one more important issue. The problem is not just deficits. In April 2004, Members may recall that we warned the Government about the impact of the European working time directive. I shall not rehearse all the arguments, but it was clear that if the Government did not secure an amendment to the directive there would be serious consequences for services. The Government claimed that would not be the case. The right hon. Member for Barrow and Furness (Mr. Hutton), now the Secretary of State for Work and Pensions, said that they would maintain access to services despite the working time directive. But what has happened?
	I shall quote from a document about changing maternity and paediatric services produced by the Manchester SHA. Manchester itselfnot the whole north-westis a good example, as it is not generally driven by deficits and ended last year with a health economy in surplus. The document states:
	Staffing pressures on the 13 units providing in-patient care are getting worse. Already children's wards and maternity units have to close on occasions because there are not enough staff to cover them safely. We will not be able to staff all these units by 2009 when the European Working Time Directive becomes law and doctors are not allowed to work the hours they currently work. This is already resulting in units being closed frequently. In 2002 there were over 200 closures to the admission of children and young people across 13 hospitals, due to either a shortage of doctors or a shortage of specialist nurses.
	If the Government had done what they said would do, they would have secured an amendment to the directive. Their replies to me make it clear that they tried to do so when they held the presidency. They took the matter to the Employment Council in December 2005 but they failed, and they have not attempted to do anything since. They must do something.
	Will the Government do what Lord Huntthen a Health Ministersaid he would do on 4 March 2003? He said that if there were difficulties, the further extension of the working time directive, due in 2009, could be deferred until 2012 and that instead of a 48-hour week, it would be possible to go up to 52 hours. Will the Secretary of State do that?

Several hon. Members: rose

Andrew Lansley: No, I am not giving way, as I am moving towards my conclusion, but before I do so, I want to be fair to the Government. We are talking about work force planning and because I wanted to understand the Government's approach towards it, I looked at their evidence submitted to the Health Committee, which is currently investigating the matter. Here it is. The Government say that there is now a streamlined framework for work force planning. There are workforce directorates within strategic health authorities and they work with the social partnership forum, with the workforce programme board, with the national workforce group, with the workforce review team, with NHS national workforce projects, with Skills for Health and with NHS employers. There is even a diagram to explain it alland all that is supposed to be the streamlined framework! Whatever it is, it is certainly not yet streamlined enough. We need a much better system because out there in the NHS, staff have no idea what the work force plans look like, as even now, posts are being cut.
	The staff of the NHS are, as we have said, its greatest asset. They work miracles daily and we need them to be motivated and inspired, but at the moment they are demoralised. The Secretary of State has gone from her best year ever in May to a very difficult year by September. NHS staff are seeing a feast turn into a famine. They see promises of expansion turn into cutbacks and they see the advertising campaigns of three or four years ago to recruit new nurses and therapists turning into the cruel irony of people leaving training unable to pursue their vocations and find jobs. They see sham consultations over service reconfigurations driven by short-term financial expedients.
	The staff also note how the effects of the European working time directive are dressed up to suggest that services have to be shut down because they are deemed unsafe. Frankly, that is a slur on NHS staff. People are working across the country to save their local NHS services. Labour Members should not decry that as a Tory conspiracy; it is happening because people are angry about the loss of their local NHS services. They do not want to block changes, but they want them to be guided by evidence and to take account of needs for accessible services.
	The new chief executive of the NHS says that more than one in four of district general hospitals have to be downgraded. He then tells us, in an interview in  The Guardian, that he understands the politics of it. Well, we do not need an NHS chief executive who understands politics, but one who is focused on patients. We need a chief executive who is not spending all his time trying to work out what Ministers want him to do, but assessing what is in the best interests of patients and the NHS. We need an NHS free of the Secretary of State and the chairman of the Labour party sitting down with their advisers, trying to decide which hospitals to close.
	I am an optimist. I believe in the NHS and I believe in what NHS staff can achieve, but they can do so only if we give them the framework, the resources and the freedom to deliver. That is our objective, so I commend the motion to the House.

Patricia Hewitt: I beg to move, To leave out from House to the end of the Question, and to add instead thereof:
	welcomes the Government's historic investment in the NHS since 1997, trebling funding by 2008; pays tribute to the commitment of NHS staff; recognises the ongoing investment in their training and development; notes that there are now 32,000 more doctors and 85,000 more nurses, and that overall there are over 300,000 more staff working in the NHS; acknowledges that as a result of the Government's investment and reforms and the hard work and dedication of NHS staff, virtually no-one now waits more than six months for their operation whereas in 1997, 284,000 people waited longer than six months with some patients waiting up to two years; further notes that over 99 per cent. of people with suspected cancer are now seen by a specialist within two weeks of being referred by their general practitioner, up from 63 per cent. in 1997, and that death rates from cancer and heart disease are falling faster than ever before; and further recognises the need to ensure NHS services continue to change to benefit from new medical technologies and treatments which mean more care can be delivered in local communities and people's homes.
	Mr. Speaker, the hon. Member for South Cambridgeshire (Mr. Lansley) has spent nearly 40 minutes telling us, as he always does, what is wrong with the NHS. I want to start by congratulating the staff of the NHSmore than 1.3 million committed and dedicated men and women, many working in very difficult circumstances. There are more than 300,000 extra staffmy right hon. Friend the Prime Minister slightly understated the increase in Prime Minister's questionsthan there were in 1997. I particularly want to thank them for the improvements that they have made in looking after patients in recent years. We have seen dramatic improvements in waiting times, for example.

Andrew Gwynne: With additional new money, the NHS has improved dramatically. We have perhaps forgotten that in the 1990s we used to worry about the number of years that patients had to wait for treatment, whereas today we worry about the number of weeks. That is not from the Whip's brief, as the point comes from the director of public health at Stockport primary care trust. Does my right hon. Friend recognise that that professional view represents the reality of what is happening out there?

Patricia Hewitt: My hon. Friend is absolutely right: he is in touch with what is happening in his local NHS.

Several hon. Members: rose

Patricia Hewitt: I shall give way again in a few moments.
	In 1997, 284,000 people were waiting more than six monthssome for more than two yearswhereas today almost nobody waits more than six months and the vast majority are treated far more quickly than that.

Lindsay Hoyle: I am sure that my right hon. Friend would want to congratulate workers at Lancashire teaching hospitals on their dedicated work in ensuring that the quality of lives in Lancashire continues to improve. Does she support the continuation of the work at those hospitals and will she ensure that it does not go to the private sector, which would put them at risk?

Patricia Hewitt: I join my hon. Friend in congratulating the staff at those hospitals. As he well knows, the Government and I have supported both investment and reform from the outset, including, where it will help cut waiting times and secure even better care for NHS patients, the use of the independent sector.

Michael Fallon: While she rightly congratulates existing staff, what does the Secretary of State say to those newly qualified midwives and physiotherapists who were promised a job in the NHS only to find that they cannot get one? Why has she made such a mess of work force planning?

Patricia Hewitt: We have never made promises to NHS staff that either we or the Opposition could not keep. What we are saying to newly qualified staff, some of whom are indeed struggling to find a job, is that we will do everything possible to ensure that they get one. In some parts of the country, NHS hospitals are working with other organisations to ensure that, if a permanent job is not available for newly qualified nurses and midwives, they are at least taken on temporarily so that they can continue to build their skills and contribute to the NHS.

Several hon. Members: rose

Patricia Hewitt: I want to make some progress before giving way again.
	I also want to thank NHS staff for dramatic improvementsbelittled, I have to say, by the hon. Member for South Cambridgeshirein cancer care. I do not think that any of the 50,000 cancer patients who are alive today because of improvements in cancer care would want to belittle them and neither would the hon. Gentleman's view be shared by cancer patients who have seen dramatic improvements over the last 12 months. Just 12 months ago, fewer than seven out of 10 patients with most suspected cancers could count on being seen, diagnosed and then beginning their treatment within two months. Today, nearly 95 per cent. of patients are doing so. That is the result of the incredibly hard work of staff, more money, which the Conservatives voted against, and the targets set for cancer care that the Conservatives would abolish.

Dari Taylor: On that very point, I would greatly appreciate it if my right hon. Friend would keep certain facts to the forefront of the debate. In North Tees hospital, for example, 100 per cent. of all breast cancer patients are seen and treated within 62 days. That is a superb achievement, which no one in the House should ever do anything other than congratulate.

Patricia Hewitt: My hon. Friend is absolutely right. It is a superb achievement when 100 per cent.well beyond the target that we setare being seen, diagnosed and beginning their treatment. That is one of the ways in which survival rates from cancer will be improved.

Several hon. Members: rose

Patricia Hewitt: I give way to the hon. Member for Buckingham (John Bercow).

John Bercow: Ministers have frequently assertedthey are right to do sothat early intervention is vital to help children with speech and language difficulties. As the Secretary of State knows, I have a strong and continuing personal interest in that subject. Given that the Vale of Aylesbury primary care trust is now turning away new referrals and inviting hard-pressed parents to seek help privately, what does the Secretary of State say to those parents who, in a million years, cannot afford to do so and who, without immediate and practical help, will find that their children's future prospects are permanently damaged?

Patricia Hewitt: First, as the hon. Gentleman knows because I have written to him on this point, I have already ensured that the Nuffield speech and language unitan issue that he has specifically raised on many occasionswill continue to treat patients. [Hon. Members: What about the Vale of Aylesbury?] Funding for the Vale of Aylesbury primary care trust has increased by more than 30 per cent. over the past three years, by 40 million. In Buckinghamshire PCT, over the next two years, there will be an additional 91.5 million. However, what we must doOpposition Members refuse to accept thisis support the NHS in making decisions that are often difficult, to get better value for that money, to release the savings that it needs to pay for more speech and language therapists, for new drugs and for all the other services that need improving. The hon. Gentleman is not willing to accept that, any more than are other members of the Conservative party.

Andrew George: Although I do not doubt the Secretary of State's sincerity, I hope that she will visit Cornwall to see for herself the impact of the reforms that she and others have been implementing in areas such as my constituency. Despite the protestations that her Department is not enforcing the diversion by local trusts of NHS resources into the private sector, is she aware that, in fact, patients who are facing unnecessary, enforced minimum waits, including waits of more than nine weeks for breast care at the moment, receive unsolicited calls from NHS managers inviting them to be seen sooner in the private sector? Will she come to Cornwall to see the results of those reforms and their impact on the financially hard-pressed service there at present? In fact, it is a financial mess. People are waiting unnecessarily and the money is going into the private sector instead.

Patricia Hewitt: My hon. Friend the Under-Secretary of State for Health will indeed shortly visit Cornwall; I hope to do so in the near future. There are indeed some real challenges not only in the hon. Gentleman's constituency, but across Cornwall, in ensuring that the enormous amounts of extra money that we have put into the NHS in his part of the country are used to the best possible effect to ensure that patients get the best and fastest care everywhere. However, the NHS in the south-west has made superb use of the independent sectorfor instance, at the Shepton Mallet treatment centreto speed up the treatment of patients who need orthopaedic operations and to do so in co-operation with the rest of the NHS in an integrated fashion.

Several hon. Members: rose

Patricia Hewitt: No, I am going to make some progress before I give way again.
	Every debate about the NHS is important to all of us, but I was looking forward to this one with particular anticipation. This week, we have had the first sighting of a rare birdConservative policy on the NHSbut what a disappointment. What we heard from the hon. Member for South Cambridgeshire today and from the right hon. Member for Witney (Mr. Cameron) earlier this week was the mishmash of confusion and contradiction that we have come to expect from the modern Conservative party.
	The leader of the Conservative party says that he will guarantee the NHS the money that it needsa guarantee from the party that starved the NHS of funds for 18 years and a guarantee from the party and the leader who voted against the increased, record funding that we have put in? Conservative Members pretend, and they do so to NHS staff, that they can promise a blank cheque, but they also promised a new economic policya new fiscal rule, no lessthat would mean 17 billion less for public services, including the NHS, this year. On top of that, their policy commission on taxation wants 90 billion of tax cuts. It does not begin to add up to a policy.

Charlotte Atkins: Hon. Members on both sides of the House are unanimous in praising NHS staff for their achievements, but are they unanimous in their views on funding Agenda for Change, particularly NHS staff pensions?

Patricia Hewitt: My hon. Friend makes a very important point. Of course, what the hon. Member for South Cambridgeshire did not bother to mention, as he talked about NHS staff, was that he is against the agreement that we have just entered into on public service pensions. He is against it, just as he was against proper funding for Agenda for Change.

Geraldine Smith: Does my right hon. Friend agree that the British people might remember what the state of the NHS was before 1997, when people lay dying on trolleys in hospitals, when people sometimes had to wait five years for cataract surgery and many years for operations and when the Conservatives would not put the necessary resources into the health service? They are a disgrace and an embarrassment when they talk about the national health service.

Patricia Hewitt: My hon. Friend is absolutely right, and the position is in fact even worse than she and I have described. The Conservatives now say that they want fair funding in the NHSfairness from the Conservative party?

Crispin Blunt: Will the Secretary of State give way on St. Helier?

Patricia Hewitt: Not yet; in a moment.
	I, too, have a copy of the Conservative party's campaign pack. The Conservatives claim that
	some areas with a low disease burden, but deemed to be socially deprived, receive much more funding than areas deemed to be affluent but with a high burden of disease.
	They go on to complain that
	some areas of Manchester receive 66 per cent. more NHS funding per head than some areas of Bedfordshire and Hertfordshire.
	Let me tell the House about some areas of Manchesternorth Manchester, for instance, where a baby is twice as likely to be stillborn and 10 times more likely to die before the age of one as a baby in south-east Hertfordshire or South Cambridgeshire.  [ Interruption. ] The hon. Member for Beverley and Holderness (Mr. Stuart), from a sedentary position, and the hon. Member for South Cambridgeshire complain that inequality in infant mortality is widening, but they want to take the money away from areas where infant mortality is worst [ Interruption ]north Manchester, where an adult is 50 per cent. more likely to die prematurely of cancer than one in St. Albans, South Cambridgeshire or south Oxfordshire.
	In north Manchester, every GP has to look after about 2,500 patients; a GP in South Cambridgeshire has, on average, about half that number. That is why NHS funding this year is 1,600 per person in north Manchester and 1,000 per person in St. Albans, south-east Hertfordshire, South Cambridge and south Oxfordshire.

Several hon. Members: rose

Patricia Hewitt: I shall give way to the hon. Member for Reigate (Mr. Blunt) on St. Helier; he has been very persistent.

Crispin Blunt: Since we were last here, the Secretary of State has had to reverse the quite disgraceful decision that she took on 19 December 2005, to overrule a consultation that had the full support of the local medical community to build a new hospital at Sutton, not at St. Helier, and to site the thing at St. Helier, at the request of the hon. Member for Mitcham and Morden (Siobhain McDonagh). The Secretary of State was then taken to judicial review by Reigate and Banstead council and Surrey county council. The case would have gone to court in about a month's time; but, in August, she gave in. Will she repay the costs of the legal action that had to be taken, because her action was so unreasonable, to Reigate and Banstead council and Surrey county council?

Patricia Hewitt: My decision was made precisely on the grounds of health inequalities and fairness, in which the hon. Gentleman and the Conservative party simply are not interested. The reason why things have moved on is that, unfortunately, the financial situation in south London, in that part of the NHS, is worse than those involved believed it to be when they came up with the plan for a new hospital. It is, I am afraid, no longer clear that the proposal for a new critical care hospital and nine new community hospitals is affordable in the way that the local NHS originally planned it. It therefore makes sense to look afresh at that model of carewhich, in principle, is the right oneto ensure that it is affordable before any further decisions or arguments take place about where the hospital is sited.

Several hon. Members: rose

Patricia Hewitt: I will give way to my hon. Friend the Member for Warrington, North (Helen Jones).

Helen Jones: May I suggest that my right hon. Friend has omitted another strand of Tory party policy that is very clear? The Leader of the Opposition made it clear on Any Questions? in 2001 that he did not want to fund the NHS in the same way that it is funded now. He said that we should have more social insurance schemes, and he has never resiled from that comment. What effect does my right hon. Friend believe that that policy would have on our most deprived areas?

Patricia Hewitt: My hon. Friend is absolutely right about the views of the right hon. Member for Witney. Indeed, let us remember that only last year he wrote the Conservative party manifesto that proposed to take millions of pounds out of the NHS for everybody and put it into subsidising private care for a few. That is what the Conservative party means by fairness.

Several hon. Members: rose

Patricia Hewitt: No, I want to make some progress.
	Conservative Members and the Conservative party refuse to accept that overspending has to be put right where it has taken place. They refuse to accept that it is wrong that a minority of hospitals and other organisations have overspentsome of them, I am afraid, for many yearsat the expense of the majority who have been in balance or in surplus. Conservative Members have a simple solution to the overspending that has taken place in Bedfordshire and Hertfordshire even though the hon. Member for South Cambridgeshire did not come clean about it today. They want to take the money away from north Manchester and all the other parts of the country with the worst health needs and the worst health inequalities.

Mark Prisk: What does the Secretary of State say to the excellent staff at the QEII hospital? Two weeks ago, she met the senior management in Bedfordshire and Hertfordshire and two senior clinicians have now told me that she made it perfectly clear that the QEII will go, Hemel will go and our new hospital at Hatfield will go. Will she now put it on record that that is not her view and that that will not be the end result? The irony is that the end result would be one hospital in Stevenage, which is Labour, and one hospital in Watford, which is Labour.

Patricia Hewitt: The hon. Gentleman should know because everybody who has looked at this

Mark Prisk: Are they safe?

Patricia Hewitt: Just let me answer [Interruption.]

Mr. Deputy Speaker: Order. The hon. Gentleman has asked a question and the least that he can do is let the Secretary of State answer.

Patricia Hewitt: I am most grateful to you, Mr. Deputy Speaker. The hon. Gentleman should knoweverybody in the NHS in Hertfordshire who has looked at the issue knowsthat there needs to be a reorganisation of hospital services in that county. There needs to be a reorganisation of hospital services in order to keep up with modern medicine, to give patients better and safer care and to ensure that Hertfordshire does not go on overspending at the expense of other parts of the country that are far worse off. Those decisions will be made only after full and proper consultation with his constituents and everybody else in Hertfordshire and they will be made on the basis of what is clinically right for patients and not on the basis of party politics of any kind.

Barbara Keeley: Conservative Members might have understood the issue of health inequalities a little better if they had bothered to turn up to the excellent event put on by the Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint). It gave profiles for areas so that I and my hon. Friend the Member for Wigan (Mr. Turner)we were the only two Members thereunderstood that Salford and Wigan, which are the areas closest to us, had very severe health inequalities and health needs. Does my right hon. Friend agree that given the resources that were needed to put on that event, it was a pity that Conservative Members, who do not understand the issue, did not bother to turn up?

Patricia Hewitt: I absolutely agree. The Conservative party's policy of taking from the poor and giving to the rich, which is precisely what they are campaigning for, just shows that it has not changed an inch.

Howard Stoate: Conservative Members are missing the point of what patients want. Patients want three things: they want greater preventive services, they want services nearer to the community in which they live and, when they need expensive, high-tech services, they want them quickly and efficiently. What they want as the result of the new GP contract is to have more pharmacists and GPs working together to provide far more screening, far more care closer to home and far more preventive medicine with greater use of statins and ACE inhibitors. All that reduces the need for people to go to hospital at all and that is what patients are calling forgreater prevention, more care in the community and, when they need high-tech care, that care being available swiftly and in a centre that has all the expertise that it needs.

Patricia Hewitt: My hon. Friend is a GP and serves on the Health Committee and he is absolutely right. The contradictions that we have been pointing out in Conservative health policy do not end there.

Andrew Lansley: The Secretary of State is not addressing the questions in the debate, but the issue is simple and we take exactly the same view as the NHS Confederation. Resources that are being allocated across the country to deal with health inequalities and that should be directed towards public health measures should be in separate budgets from resources allocated in relation to the burden of disease in an area in order to ensure that there is equitable access to care.
	The principles that we set out on Monday are very clear and involve equitable access to service delivery so that we do not arrive at the positionit happens nowwhereby I can stand in the stroke ward in Luton and Dunstable hospital and be told that there are two kinds of discharge arrangements. The first is for patients going to Luton, where the PCT has enough money to provide follow-up and rehab, and the other is for Bedfordshire Heartlands, which is in deficit and cannot provide those services. That is not fair to patients.

Patricia Hewitt: It is not fair to patients, but the answer is not to take money from the poorest areas with the worst problems and to give it to Bedfordshire, which has been overspending. The answer is to reorganise services in Bedfordshire. I spent a day a couple of weeks ago with community matrons in Bedford and they support patients with long-term conditions in their own homes and that slashes the need for those patients to go into emergency care. That is the kind of change that we want to lead.

Several hon. Members: rose

Patricia Hewitt: I will not give way, as I want to make progress.
	The Conservative party has told us this week that it wants an independent commissioning board completely free to decide where patients should be treated, but it opposes any change in NHS provision, including, it appears from one Conservative Member, the involvement of Age Concern in providing some services. It says that it wants to put decisions in the hands of NHS professionals but, every time the local NHS proposes to make a change in the organisation of services, members of the Conservative party are out marching in the streets to oppose it. They protestthey have been doing it again this afternoonagainst every closure of a community hospital.
	Conservative Members should go to Norwich and talk to Tony Hadley, the brilliant nurse manager whom I met recently who worked with his nursing and community team to reorganise community hospital services. They cut the number of community hospital beds, they closed some wards and closed two community hospitals and centralised them in a third. Conservative Members are out on the picket lines when anything like that is proposed in their constituencies, but what Tony Hadley and his team did in Norwich was to listen to patients who want to be cared for at home rather than in hospital and they put half the staff out of the community hospital and into the community itself. They doubled the number of patients that they could care for, they slashed the number of emergency admissions and they saved 1 million a year that can go into better care for other patients. The Conservative party has to decide whether it is for or against that.

Graham Stuart: I hope that the Secretary of State will recognise that no one on the Conservative Benches wishes to set community hospitals or other health services in aspic. We are perfectly happy to welcome change, but we do object to the cuts in local services that are precisely against the vision that she set out in January this year. That is what we are protesting against, and it is the cuts right across the country that upset not just Conservative Members but, if she cares to look behind her, those on the Labour Benches as well.

Patricia Hewitt: I am afraid that the hon. Gentleman is simply incoherent on this point. It is not possible to take advantage of all the changes in modern medicine that make it possible to take tests and treatments out of acute and community hospitals and into GP surgeries, health centres and patients' own homes, which is where patients would rather be, without making difficult decisions about the numbers of beds, wards and cottage hospitals that we have. The hon. Gentleman and the Conservative party need to be willing, for once, to support the NHS in making difficult decisions that will improve care for patients.

Rob Marris: Does my right hon. Friend share my dismay at the fact that the hon. Member for South Cambridgeshire (Mr. Lansley) wants to stop the NHS being a political football, yet the Conservatives seem to be obsessed with the number of posts in the NHS rather than the quality and quantity of output? Does she agree that it is somewhat hypocritical of the Conservatives to bang on every year in Finance Bill debates about productivity in the NHS, but to criticise her all the time for trying to address some of those issues and the configuration and suitability of services?

Patricia Hewitt: My hon. Friend is right. The Conservative party says one thing to one group and a completely different thing to a different group. Conservatives say that they are in favour of more health care close to people's homeswe have just heard it againbut when emergency admissions are cut, as community staff are doing all around the country, when there is more day-case surgery, and some hospitals are not doing enough, and when the average length of stay is reduced, as all the best hospitals are doing, we do not need as many acute beds in some hospitals and we do not need as many staff in those hospitals. When a hospital makes such difficult decisions, and when it makes difficult decisions to bring the NHS back into financial balance instead of allowing the problems to build up over and again and to get worse and worse, the Conservative party completely refuses to support them.

Sandra Gidley: We keep hearing the mantra that services are being reconfigured and moved into the community, which many would regard as quite a good thing, but will the Secretary of State explain why the Council of Deans and Heads of UK University Faculties for Nursing and Health Professions has stated that the cuts in training budgets have had a
	particularly severe effect in community nursing?
	If the Government are keen on realising what they state regularly, surely we should be increasing such budgets.

Patricia Hewitt: As the hon. Lady will know from the NHS work force figures, despite the fact that there has been a decrease, as the hon. Member for South Cambridgeshire was saying, in the number of health visitors, there has overall been a significant increaseof about 27,000, I thinkin the number of nurses working in the community. We should expect to see that trend continue. One thing that we need to do, which I have asked our chief nursing officer to take charge of, is to modernise nursing careers so that we can support more nurses in the community.

Paddy Tipping: The Secretary of State has talked about change and difficult decisions. She knows the position in Nottingham well. She recently visited the new Nottingham University Hospitals NHS Trust and she knows that services are being reconfigured there, and it is difficult and painful. Does she accept that it takes time to make those changes and will she give the new trust time to put those changes into place?

Patricia Hewitt: My hon. Friend makes an important point. As he says, I spent quite a lot of time recently with staff at Nottingham University Hospitals NHS Trust. It is indeed in a very difficult position, as is the partnership trust, as I know he will accept. The latter has massively improved services for mentally ill patients but has had over many years to give up some of its urgently needed funding to bail out the acute hospital. I have already asked the NHS in the east midlands to look at the length of time needed for the Nottingham acute trust to make the necessary changes.
	Given that both my hon. Friend and the hon. Member for South Cambridgeshire have raised the issue of risk to significant numbers of jobs in some places, I draw the attention of the House to the fact that Mid Yorkshire Hospitals NHS Trust, for instance, which notified the Government of up to 400 jobs at riska matter of considerable concern and great anxiety for the staffhas in reality had to make only six staff compulsorily redundant. We would all wish that there had been none at all, but that is very different from the headlines.
	Worcestershire Acute Hospitals NHS Trust identified that it needed to lose the equivalent of 670 jobs, including of course agency workers and so on. It notified the Department of Trade and Industry of 250 jobs at risk. It has made only 19 redundancies. We will support any staff member who loses their job or needs to move to a new one; none the less, those hospitals like every other have continued to reduce waiting times. It is essentialthe hon. Member for South Cambridgeshire continues to refuse to accept this pointthat hospitals continue to become more effective in their use of resources in order to give even better value for money, so that we can free up the money to pay for extra treatments and extra drugs for other staff to use.

Greg Hands: Two months ago, it was announced that Ravenscourt Park hospital in my constituency will close in November. It was opened only three years ago. The then Health Minister, the right hon. Member for Barrow and Furness (Mr. Hutton), said at the time:
	We have spent 10 million on improving Ravenscourt Park Hospital. When the NHS took over this hospital, it had 16 beds; now it has 106, and is treating upwards of 3,000 patients a year. That means improved quality of service for NHS patients, who are being treated in state of the art facilities. That is what investment and reform of the NHS is helping to bring about.
	Only three years later to the very month, the hospital is to close. Will the Secretary of State explain that, and will she be sending one of her Ministers to the closing ceremony next month and apologising?

Patricia Hewitt: Ravenscourt Park hospital was an investment from the private sector. It went bankruptor pretty nearly so. We bought it for a very small amount of money and we did put some investment in it. It has treated a relatively small number of patients. I do not have the figures to hand, but it has never had anything like an acceptable level of bed use, because there are in fact enough beds and still some efficiency gains to be made in other hospitals that serve the hon. Gentleman's constituents and other parts of west London. The Conservative party has clearly given up completely on economic stability and sound finances. I take an old-fashioned view of these matters: I believe in prudent use of public money. I believe that we hold taxpayers' money in trust. I do not believe in keeping a hospital open if there are not enough patients to use it when they can be very well treated in other hospitals in that part of London.

Patrick Hall: From recently visiting Bedford hospital and talking to staff, my right hon. Friend will know that they and others in the community have concerns about what is called reconfiguration. Does she agree that the best thing to do in that circumstance is to wait for the proposals to be made by a strategic health authority and hospital trusts and others, so that people can then have a measured, informed, balanced debate about the future shape of health services? Did she notice that the hon. Member for South Cambridgeshire (Mr. Lansley) anticipated the outcome of the acute services review, the results of which have not yet been published, and is stirring up fears and unhappiness? That is not the way to improve the future of our health service. We should wait for the proposals and then have a proper debate about them.

Patricia Hewitt: My hon. Friend is right. Having met him twice recently in Bedford, I compliment him on the fact that he is indeed trying to ensure that there is a measured debate involving clinicians as well as patients and the public on the best way of organising services for patients in his constituency and other parts of Bedfordshire. It is absurd and unfair to patients for people to be campaigning to save a hospital when there is no proposal to close it and there is to be no proposal to close it.

Nick Palmer: I concur with the point made by my hon. Friend the Member for Sherwood (Paddy Tipping). It is important in a difficult merger situation in Nottingham that we have time to ensure that the process is efficient and effective for patients. Does my right hon. Friend agree that Opposition parties' campaigning on the structure of the NHS is unnecessarily alarming patients? Although it is entirely understandable that staff are worried over mergers, patient care is better than it has been for many years.

Patricia Hewitt: My hon. Friend is correct. The truth is that the Conservatives simply will not face up to any difficult decisions. They want theirs to be the party of economic stability, but they pretend that the NHS can have a blank cheque and they promise their business friends a tax cut. They say that they support the staff, but they promise to scrap the agreement on public sector pensions and the hon. Member for South Cambridgeshire has the nerve to attack the new chief executive of the NHS, a distinguished public servant whose appointment has been welcomed across the NHS. They say that they want to devolve decision making to the front line, but they oppose the local NHS every time it makes a proposal to get better value for money and improve patient care. They say that they have been converted to the cause of fairness, but they want to rob the poorest communities in our country.

Grant Shapps: Will the Secretary of State give way?

Patricia Hewitt: No, I will not.
	The Conservatives want to be all things to all peopleold Tory, new Tory, left, right and centre Torybut they are being found out, because the more the British people hear from the Conservative party, the more they see the contradictions, confusion and intellectual dishonesty, the more they realise that, try as the Tories might, they cannot take the con out of Conservative. That is why the British people will never trust the Conservative party with the NHS. I commend our amendment to the House.

Steve Webb: Let me join in the one note of consensus between the Government and Conservative Front Benchers by recognising and valuing the work that is done by almost 1.4 million people in the NHS. They are, rightly, the focus of today's debate.
	When we heard that the Conservatives proposed to spend a whole day talking about the NHS, we looked forward to seeing the motion for debate. We imaginedrather naively, I acceptthat it might contain some answers. Given that, on Monday, the Conservative leader, the right hon. Member for Witney (Mr. Cameron), made a big speech about the NHS to tell us about his plans, I hoped that we would have the opportunity to see some more detail of those plans in the motion and to debate them. I was therefore startled to read the motion. I looked for something that was actually being called for, but first I found that the House is alarmed in line 2, is deeply concerned in line 3, condemns in line 4, regrets in line 5, and further regrets in line 7. We have to go to the penultimate line to find something that the Conservatives are calling for, which is the potential of health care staff to be used. I cannot disagree with that. We considered tabling an amendment that would simply add and regrets the inability of Her Majesty's official Opposition to have anything to say on the subject, but, as a responsible and effective Opposition, we decided to table a substantive amendment.
	Several hon. Members have waved around the Stop Brown's NHS Cuts campaign document, which is being circulated widely. At the bottom of the page, we have a picture of the Chancellor with his scissors out, but we have heard the Conservative leader say that he cannot guarantee that any of the cuts planned would not happen if he were in charge. The Stop Brown's NHS Cuts campaign should therefore be called the Stop some of the cuts, but we can't tell you which ones campaign. Something tells me that, in every locality where the Conservatives are campaigning against a cut, they will say that that cut is one that they would stop and it is one of the others that they might not.

Graham Stuart: As the hon. Gentleman is aware, the Conservative party, unlike his own, has a prospect of entering government, so it tends not to make promises on expenditure without being wholly sure of what it can do. However, every Conservative Member knows full wellI hope that he accepts thisthat the financially driven changes and cuts in staff and services would not happen in an independent NHS, freed from the political interference and control of both the chairman of the Labour party and the Chancellor of the Exchequer.

Steve Webb: That is very interesting. If an independent NHS is central to fighting the cuts against which the Conservatives have started to campaign, why is it not mentioned in the motion? I just wondered.
	The hon. Gentleman suggests that, if the Conservatives were in charge, we would not see financially driven cuts. I have to exempt him from blame, because he was not a Member of Parliament when the right hon. Member for Witney, now the leader of his party, opposed 8 billion for the NHS in the National Insurance Contributions Act 2002. I read the Conservative Q and A document on that subject, and this is what I found. The question asked is:
	Didn't the Conservatives vote against every penny of the extra investment the Labour Government has put into the NHS?
	The answer is:
	This is just classic spin.
	Classic spin it may be, but I have here the Division lists from the Second Reading of the National Insurance Contributions Bill. The hon. Member for Buckingham (John Bercow) led for the Opposition in that debate, and he took an intervention from a little known Back Bencher representing Witney. That Back Bencher attacked the national insurance rise for the NHS, asking
	Has my hon. Friend calculated the effect of increased national insurance contributions on trying to hire badly needed staff in our hospitals?
	Whatever happened to him? The reply from the hon. Member for Buckingham was:
	the bull-headed and short-sighted policy on which the Government seem intent will make a difficult task much more difficult.[ Official Report, 13 May 2002; Vol. 385, c. 543.]
	In other words, when it came to the crunchwhen it came to putting their money where their mouth waswhere were the Tories? In the opposing Lobby.
	Were that an isolated incident, a one-off, I might forgive the ToriesI am a very forgiving chap. Unfortunately, however, they have form. I asked the House of Commons Library for figures on real spending on the NHS. I was only interested in what had happened under Labour, but the Library staff inadvertently included on the chart the final year of Tory Government, which showed a real-terms cut. The last time the Tories controlled the purse strings, they cut NHS spending.

Stewart Jackson: I am glad that, true to form, the Liberal Democrats have not risen above the student union politics that we expect from them. As long as discouraging intellectual argument can fit on the back of a Focus leaflet, that is fine. The hon. Gentleman should know that, in fact, in the period between 1979 and 1997, under Conservative Governments, real capital expenditure on the NHS increased by 60 per cent. above the rate of inflation. I am happy to correct him.

Steve Webb: I am delighted to hear that. I wonder whether the hon. Gentleman can explain the following: if 8 billion of the approximately 80 billion currently being spent on the NHS is paid for by the 1p on national insurance contributions, which 8 billion does he think should not be being spent? A campaign against cuts is being run by a party that said that we should be spending 10 per cent. less than we are now. It is hard to reconcile those statements.
	I would be prepared to forgive the Conservatives twice, in fact. I would forgive them real-terms cuts in the run-up to an election and I would forgive their later voting against the money. We therefore have to look at the manifesto on which every single Tory Member of Parliament was elected.

Stephen Dorrell: Will the hon. Gentleman give way?

Steve Webb: I shall in a momentperhaps the right hon. Gentleman will be able to explain what his manifesto called for. For those who could afford from their own resources to buy their way out of the NHS, the manifesto called for a subsidy from the taxpayer to enable them to do so. That is at the core of the Tory vision of public services: not excellence for the many, but enable the few to buy their way out.

Stephen Dorrell: May I suggest to the hon. Gentleman, with respect, that he leave the Government's propaganda to the Government? He is looking at the Division list on a national insurance tax increase and linking the 8 billion that was the result of that tax increase to increased NHS expenditure. That is the Government's line, but it does not need to be the Lib Dems'. If he looks at the Budget for that year, he will find that the biggest single increase in public expenditure in the year in which that Bill raising the money to pay for it went through, was not for the national health service at all. The biggest single increase in public expenditure that year went into the social security budget, so why does the hon. Gentleman feel it necessary to accept the branding that the Chancellor of the Exchequer attached to a tax increase in order to make a spending increase on social security sound more acceptable by saying that it went into the national health service, when it did not?

Steve Webb: I must be fair to the right hon. Gentleman. I checked the Division list while he was speaking and he is not guilty. He was obviously otherwise engaged at the time. I have some sympathy with the point that he makes. Simply because the Chancellor labels something does not automatically mean that it is so. I am very much of that view, but if we did not have the 1p on national insurance, which we supported and which we warned before the 2001general election would be required but which Labour never quite got round to mentioning, we would have 8 billion less of total Government revenue. We can argue about where that would come from, but clearly it is ring-fenced and earmarked for the NHS by statute, and that is the right place for it.

Andrew Lansley: As my right hon. Friend the Member for Charnwood (Mr. Dorrell) rightly points out, it is a fiction that the change in national insurance directly determined the level of NHS expenditure. If the hon. Gentleman looks at the accounts for last year, as I am sure he has done, since he is a professor, he will find that national insurance provided 1.5 billion less to the national health service than it was expected to provide. Did that change the amount spent by the NHS? That is separately determined in public expenditure through the vote. The point that we were making in 2002 related to the economic consequences of the way in which the Chancellor would raise the money. That is why, at the subsequent election, we committed ourselves to maintain that level of expenditure, but of course my right hon. Friend might have chosen to raise the money in a different way.

Steve Webb: I am interested in the hon. Gentleman's claim that the Conservatives would maintain the expenditure. If the patients' passport that his leader wrote into the manifesto had been implemented, money would have had to be found to subsidise people to buy their way out of the NHS. Where would that money have come from?

Chris Ruane: I thank the hon. Gentleman for raising the crucial issue of financing the NHS. The hon. Member for Peterborough (Mr. Jackson) referred to the period between 1979 to 1997, when expenditure under the Tories went up by 60 per cent. May I remind the House that from 1997 to 2008, under Labour, the budget will be going up by 300 per cent.?

Steve Webb: Nobody could dispute that the rate of increase in spending under the present Administration since 1997 has been substantially in excess of what the Conservatives did or would have done, had they been in office. I am glad the hon. Gentleman mentions 1997. Part of the reason why I am addressing the House now is the record of the Tories on the NHS. In 1997, I had people coming to see me at my surgery with letters from their hospital stating that it would be two years before they could see an orthopaedic consultant to be put on the waiting list.
	The reason Conservative Members object to my raising that and think we should be attacking solely the Government is that the Conservatives are portraying themselves now as the friends of the NHS. I find that laughable. They have form. They have form in cuts in their final year in office, they have form in voting against money for the NHS, they have form in the patients' passport, and only last month the Conservative leader took out from the first draft of his speech a line that pledged to match Labour's spending on the NHS. What was that about? If the hon. Member for South Cambridgeshire (Mr. Lansley) wants to reinsert that pledge on the record, I will give way to him.

Andrew Lansley: It is clear that we were all elected on the basis that we would match Labour's planned spending to 2008-09. We have no idea what Labour's planned spending is after 2008-09.

Steve Webb: So the hon. Gentleman does not rule out spending less than Labour on the NHS.
	The hon. Gentleman said at the start that the debate was not principally about finance. One of the reasons why there are 90 per cent. unemployment rates among physiotherapists when they graduate, and one of the reasons that we are seeing redundancies, including of front-line medical staff, is the Government's mismanagement of the finances of the NHS.
	A recurrent problem throughout the debate is the issue of reconfiguration and who should decide when health services need changing for greater efficiency. At Prime Minister's questions earlier today, the hon. Member for Hastings and Rye (Michael Jabez Foster) said that, if we do not like what is to happen to our accident and emergency department, whom do we ask? What do we do about it? There is only one person who has been anywhere near a ballot box whom people can ask, and she is sitting on the Government Front Bench.  [Interruption.] The Secretary of State says overview and scrutiny. The local authority can scrutinise. What does it have the power to do? It has the power to go and ask her, and if she wishes and deigns to do so, she can refer the matter to an independent body.
	My overview and scrutiny committee asked the Secretary of State to review the closure of Frenshay hospital in my constituency. Guess what? She refused. All three parties on the council, not just the Liberal Democrats, wanted a referral. I want a referral. Anyone who had ever been elected in the area wants a referral, but the Secretary of State blocks it, so she is the one who controls these matters centrally. How is that a democratic and accountable national health service?

Simon Hughes: Does my hon. Friend acceptthe Secretary of State may anticipate thisthat that must be right because, two nights ago, I went with four Labour colleagues to see her and the Minister of State Lord Warner to ask her to reinstate some of the cuts in south London for the most vulnerable this year and to look again at some of the prospective cuts for those with mental illness? The Secretary of State very reasonably said that she would reconsider because she believed that the formula that had been arrived at in London was unfair and she would seek to have it recast to reinstate some of the funding. We hope that that will be successful. We would not have gone to see her if it were not the case that the Secretary of State for Health is able to decide what happens. In the end, she calls the shots.

Steve Webb: Indeed, except when there is bad news. When there is bad news, it is a local decision. The right hon. Lady is the Secretary of State for good news in the health service. Whenever a community hospital opens, it is because of a Government promise. Whenever a community hospital closes, it is because of local decision making.

Patricia Hewitt: Does the hon. Gentleman accept that I have been assiduous in going round the country to talk to staff in hospitals and local areas that are facing extremely difficult decisions, including Nottingham, about which we heard recently, and that I meet those staff privately to discuss the difficulties that they are facing? I do not go only to areas where everything is excellent. In the real world, most areas have to make difficult decisions to achieve the best use of their resources. Rather than continuing to sit on the fence, the hon. Gentleman must decide whether he is in favour of difficult decisions being made to get the best value, to take advantage of modern medicine and to get the best care for patients, even when that means, in his constituency or elsewhere, difficult changes.

Steve Webb: At the risk of being parochial, there is the strange coincidence that the hospital in my Liberal Democrat-held constituency closed so that a new one could be built in the neighbouring Labour-controlled constituency. We need to know that the difficult decisions that have to be made are being made on clinical grounds. All too often, it seems blindingly obvious that other factors, shall we say, come into play.
	The Government and the health service must treat the public as adults and give them the necessary information and the opportunity not to be consulted and ignored, but consulted and listened to and for their views to be acted upon. I have discovered a new word in the English languageit is sham-consultation. We cannot have the word consultation any more without the adjective sham in front of it. Throughout the country when I, like the Secretary of State, visit local people, they say, Yes, we went to endless consultation meetings, we had engagement, then consultation, then review, and then all the rest, but in the end they did what they were always going to do.
	If people are making decisions against the will of the local people, they should be people whom local people can get rid of. How can it be right that decisions affecting hon. Members' health services are made by people whom they never elected, whom they can never get rid of, and whose only right of appeal is to the Secretary of Statewho has total discretion to ignore the appeal and, if she hears the appeal, can refer it to a quango, which we also did not elect? Where is the democratic accountability in that?
	I have some sympathy with the idea of getting rid of centralised meddling, so to that extent I am with the Conservatives on the idea of independence, but it falls down because there is no democratic accountability, particularly at the local level. Local communities are frustrated because they feel that the decisions are being made for them, rather than with them. Lots of meetings take place, but how often do they change anything? That is one of the things in the health service that must be changed.
	The Secretary of State met the press this morning. She is anticipating whatever the Healthcare Commission might find tomorrow about the health service's performance. She said that we need action plans. In other words, where PCTs are found to be weak we urgently need action plans to start within a month. That typifies the Government's mismanagement of the NHS. She does not say that we need long-term strategic thinking for efficiency over a period of years or that we need deep-seated financial problems sorted out in the medium term, but that we anticipate a bad headline tomorrow, so we need an action plan and we have a montha monthto do things that presumably have not been done for the last nine years. Is that a month to put long-term plans in place; a month to consult and listen and refine? No, just a month to get them out of the mess they are in this month.
	What is happening with NHS finances is that problems that have built up over years, decades in some cases, have to be sorted out by Wednesday week. How can that be a rational way to run the health service? We have huge financial instability. The Secretary of State complained that the Tories wanted to spend taxpayers' money subsidising the private sector. The words pot, kettle and black spring to mind. Independent sector treatment centres are being given better prices than the NHS, guaranteed volumes of delivery, the chance to cherry-pick the easy hips, cataracts and scans, but at the expense of what? She mentioned the ISCT at Shepton Mallet, but that has resulted in job cuts at the Royal United hospital in Bath just up the road. Frenshay hospital will virtually close and the chances are that an ISTC will be built on the site, so the same people will be having the same procedures on the same site but done by the private sector instead of the public sector, probably at greater costand that is not privatising the NHS? I wonder what would be.

Sandra Gidley: My hon. Friend has probably also seen the predictions that many of the ISTCs will not fulfil their full contracts, so they make more money. Does he share my concern that, for example, in Southampton we are faced with a treatment centre that will take cataract operations out of the system and threaten the viability of the extremely good and useful eye unit that we have?

Steve Webb: My hon. Friend's experience is absolutely typical. It is hard to see what was wrong with the eye unit at her local hospital, yet because the Government are obsessed with marketisation, with trying to create a fake market and with trying to shake up the NHS by subsidised private competition, good quality NHS facilities are being undermined throughout the country.

Edward Vaizey: Will the hon. Gentleman therefore confirm that it is Liberal Democrat policy to close the existing ISTCs and not to open any more, or is it their policy to fund them in a different way?

Steve Webb: I can give a straight answer to thatit is Liberal Democrat policy not to subsidise ISTCs, which is what has been happening. One question that I would ask the hon. Gentleman is where is the value-added coming from? As my hon. Friend the Member for Romsey (Sandra Gidley) said, some of the ISTCs have block contracts, so they are paid for work that they do not do. The hon. Gentleman's party complains about low productivity in the NHS, whereas here the private sector is creaming it at the expense of the NHS.

Meg Hillier: Most patients go to their GP, in the vast majority of cases a private partnership, are given a prescription that they take to their local high street pharmacy, a private business, and are then given a drug from a private drug company. That is accessed free at the point of delivery, funded by the public purse, but provided by a range of providersso I am not quite sure what his argument is.

Steve Webb: The origin of the cheers says it all. The GPs are not providing services to make a profit, although the drug companies might be trying to do that. The critical point is why should the private sector have to be subsidised and bribed in order to bring it in. Does the hon. Lady support that? Does she really believe that the private sector should get more than the NHS for providing the same treatment? That is Government policy.

Andrew George: Is my hon. Friend aware that in Cornwall at the moment, despite the fact that GPs refer patients to NHS consultants, who have to operate with one arm tied behind their back, constrained by minimum waiting times, NHS managers intervene with unsolicited phone calls to offer the possibility of those patients being seen earlier in the private sector?

Steve Webb: My hon. Friend raises some very strange matters that are occurring in the NHS. I assume that the Secretary of State knows what is happening. We are supposed to have patient choice. The patient is supposed to see the GP, go through a list on the screen, pick one, and then a booking is madeexcept that someone is tapping the phone line. Someone intercepts the call, second-guessing the GP's referral, and in some cases saying, Are you sure you want to do that? Let's try to refer them somewhere else. How that squares with patient choice I am not sure. If the GP and patient jointly decide one course of action and that is second-guessed, I do not see how that is patient choice.
	My hon. Friend referred to minimumnot maximumwaiting times. We have examples all over the countrymy hon. Friend the Member for Twickenham (Dr. Cable) has raised the matter with meof people being told that they have to wait longer because there is no target at the bottom end. The people right up against the target will have priority, even if the others could be treated sooner because there is no target. Those are the sort of distortions that the Government's obsession with targets are creating in the NHS.

Howard Stoate: I have great sympathy with what the hon. Gentleman says, but he is in danger of confusing one or two issues. I work part-time as a GP and I refer people on the choose-and-book system. I bring up the list of possibilities on the screen for the patient, given his condition, and the patient then chooses the hospital and makes the appointment to suit themselves. Waiting times on choose and book are very good indeed. On occasion, a patient may choose a private sector deliverer if there is one on the list within the NHS tariff, but in my area nine times out of 10 the patient will choose a local general hospital that they have had contact with before. I do not quite understand where he sees the confusion.

Steve Webb: Perhaps the hon. Gentleman does not have referral managers in his PCT. Those are people who come between him and his referral to the consultant and suggest sending the patient somewhere cheaper. That is what happens.

Susan Kramer: Just to confirm the cases that have been brought up by my hon. Friend the Member for Twickenham (Dr. Cable), about a week ago my local GP complained to me that, having called up various consultants for treatment of his patients and been told that they and the operating theatre were available, when he tried to book in the patients he was told that there must be a 10-week delay until they are right up against the target barrier. That, presumably, is a mechanism for pushing costs, certainly within the London area, into the next financial year by delaying treatment as long as possible. My GP is very concerned about the deteriorating condition of his patients. I am now asking patients if they are willing to give me their names so that we can bring those cases forward.

Steve Webb: My hon. Friend has illustrated the consequences of the financial squeeze in the NHS. Ministers seem to think that they are running a different health service in which such things do not take place, and, as my hon. Friend has said, sometimes they do not seem in touch with what is happening on the ground.
	The focus of today's debate is the work force, and the Council of Heads of Medical Schools has rightly criticised what is going on:
	Coherence is requiredand this is sadly lacking at presentto the detriment of the entire nation.
	It is talking about the Government's failure to ensure proper work force planning. Whenever I have asked written questions about that matter, I have been told, That is the responsibility of trusts or health authorities. I sometimes think that this Government are the Not me, guv Government, because they always say that it is someone else's problem.
	Where things need to be done strategically and nationally, the Government should be planningI know that planning is a dirty word in new Labourso that people who commit their lives to the NHS by undertaking three, five or seven years of training have a good prospect of obtaining a job when they complete their training. The Secretary of State has no answer to why 90 per cent. of recently graduated physiotherapists are unemployed. Is that acceptable? Has the right hon. Lady got anything to say on the subject? All she has said is, We are trying to help. We will do what we can. The situation is totally unacceptable; it is the result of mismanagement; and the buck must stop on the Government Front Bench.
	Some things in the NHS must be done nationally, strategically and with accountability to Parliament. However, as much as possible should be done locally by local people, who should be engaged early in the decision-making process to allow them to face the difficult choices, to express their priorities and to have those priorities respected, which is not happening in the NHS at the moment.
	One important issue that has arisen in the debate is that of switching money from people with longer life expectancy to people with shorter life expectancy. There is the question whether enough money is going into the system in the south and whether too much money is going into the system in the north. How can the Conservative party run a no cuts campaign without promising to spend any extra money? It is difficult to work that one out, until one realises that, with one or two exceptions, it does not intend to win any seats north of the Watford gap. Conservative candidates in seats south of the Watford gap will say, We will spend more money in this area. If, however, we were to have a parliamentary by-election north of the Watford gap, the Conservative candidate would not mention spending less in that area.

Graham Stuart: Does the hon. Gentleman accept that the economics of the issue and health outputs both involve using the money wisely and both concern productivity, which lies at the root of the Government's failure? By reducing centralising bureaucracy and, as he has wisely pointed out, distortions caused by target setting, it would be possible to use the existing money to deliver more care. As the Labour party used to say before it got into power, which it has wasted, it is not only about money.

Steve Webb: The hon. Gentleman represents a seat north of the Watford gap, and he is right that we need to spend every penny wisely. Every incoming Government say, Vote for us and we will spend the money more wisely, but the issue goes deeper than that. The Conservative party is saying that it would spend more money in the south of England without ever saying that it would spend less in the north. The shadow Secretary of State has said that the Conservative party should regard public health money as one pot and money for illness as another pot. Those two areas are clearly separate, but the total will not changeif one area gets more, another area must get less.

Chris Mole: Will the hon. Gentleman clarify that the Liberal Democrats would not change the national distribution formula for the NHS one iota, which would help to rebut local Liberal Democrats who say, We will get back the 10 per cent. that Labour has sent to the north?

Steve Webb: The hon. Gentleman will find that his Government have reviewed the formula in the past few years. It is wrong systematically to say across the south of the England that more money will be spent there without accepting the corollary of that choice. The Conservative party is saying, Health cuts for the north, which is official Conservative party policy.  [ Interruption. ] The shadow Secretary of State has said that the board would be independent, which means that he cannot guarantee delivery. His argument is: Vote for me, and we will give more money to the south, but only if the independent board agrees to do so. Will he clarify the situation?  [ Interruption. ] Would more be spent in the south because of the formula or would the independent board decide the matter?

Andrew Lansley: It would be up to an independent board to arrive at a fair allocation of resources in relation to the burden of disease.

Steve Webb: Tory candidates who are campaigning for a change to the formula to give more money to the south cannot be sure that it would happen.  [ Interruption. ] If the independent board did not give more money to certain areas, no one could do anything about it because it would be unaccountable.

Andy Burnham: The shadow Secretary of State has said from a sedentary position that the independent board would allocate independently of Ministers the funding for each PCT.

Steve Webb: That was my exact understanding of the shadow Secretary of State's remark. At the next election, people will be asked to vote Conservative on the basis of a set of promises on the health service that will be entirely undeliverable because the health service would be run by an unelected board.
	Today's debate has provided a valuable opportunity to consider the NHS work force, but we have heard nothing from the Government about the lack of opportunities, which is due to the lack of planning for the work force. There is a place for central planning in the NHSI know that that is a lefty thing to saybut it is not happening in the marketised NHS. Physiotherapists cannot find jobs because of the lack of planning.
	More than anything else, we need an end to centralised meddling, which involves the centre dabbling, fiddling and changing when it should not do so. Every few months, managers must respond to the latest initiative and meet the next target. Unlike some, we have welcomed the money that has gone into the NHS, but we oppose the constant fiddling and meddling, without which the NHS would not face many of the pressures mentioned in the motion.

Mr. Deputy Speaker: Order. Before I call the next speaker, I remind hon. Members that a 10-minute limit has been placed on speeches by Back Benchers, and it applies from now on.

Kevin Barron: I want to pick up a point raised by the hon. Member for Northavon (Steve Webb) about independent sector treatment centres. The Health Committee submitted a report to the House and the Government in July this yearwe expect a reply to that report, which we may debate at some stage, in the next few weeks. The hon. Gentleman has stated that ISTCs are cherry-picking, but the Health Committee found no evidence on that point other than anecdotal, although I hope that hon. Members will provide evidence in this debate.

Tony Baldry: The orthopaedic treatment centre in Banbury is refusing to treat anyone under 18, anyone who lives on their own, anyone who does not have a telephone, and anyone who is overweightin other words, anyone who presents any difficulties at all. I invite the Chairman of the Select Committee to come to that centre to see exactly how it is cherry-picking.

Kevin Barron: I will have a chat with the hon. Gentleman a bit later, but if what he says is the case, it is a great pity that those findings were not at least submitted as written evidence during the Committee's inquiry, because that would have enabled us to comment on it.
	On the motion

John Pugh: Will the right hon. Gentleman give way?

Kevin Barron: No, I will start my speech, if the hon. Gentleman does not mind.
	The events of this week involving the main Opposition party leave me a little confused. On Monday, as I drove down from Yorkshire, I heard about the Leader of the Opposition's conversion in relation to the national health service, so I looked at the Conservative party's website. Two comments somewhat confused me. First, the right hon. Gentleman says that he is
	committed to the NHS idea, ruling out any move towards an insurance-based system.
	I thought that he would have flagged that up at his party conference, assuming that it agreed with that, as just a few years ago, in 2001, he said in the  Oxford Journal:
	We also need to look at a massive expansion of social insurance schemes, so that our health spending and outcomes can match that of other European countries. We want to keep and expand the NHS, but on its own it is simply not enough.
	Perhaps the Conservatives should have put that idea down for debate today.

Edward Vaizey: Will the right hon. Gentleman give way?

Kevin Barron: Not just yet.
	We could then have had a discussion about the apparent conversion that has taken place in the past six years in terms of the money spent in the national health service, and how services have kept expanding while being paid for out of the public purse and not through private insurance.
	I intervened on the hon. Member for South Cambridgeshire (Mr. Lansley) to draw attention to the extraordinary statement by the Leader of the Opposition on Monday, quoted again in the Conservative website news story:
	So my message to the Government is clear: the NHS matters too much to be treated like a political football.
	Wonderful stuff, is it not? I also have the Conservative party's NHS campaign pack, which, I understand, is about to appear on its website [Interruption.] It is not entitled save the NHS, although I may sign up to one or two things in it, and I am prepared to share a few views about it with hon. Gentlemen. It is to be launched on Saturday by the Conservative partyI presume that it will be the non-political health service football that will be launched. That pack is very good and includes materials that can be purchased for action day, graphics to download and a template press release. All people have to do is take out the italics and put in how awful the NHS is in their part of the country.  [Interruption.] Conservative Members who are making noises will find it very difficult to come to my part of the United Kingdom and fill in any type of press release saying that about the NHS there. I challenge them to come and do that on Saturday, although I will be holding a surgery.

Linda Riordan: If the Conservatives intend to launch that campaign in Halifax, may I remind them that we waited 20 years for a new hospital, and we got it in 2000 under a Labour Government?

Kevin Barron: Again, people would have difficulty taking out the italics and filling in the press release with details from my hon. Friend's area.

Grant Shapps: rose

Kevin Barron: Further to that press release[ Interruption.] I will let its author speak in a few minutes. It is different from the motion in subtle ways. It includes a template for a council motion to be tabled at local government level, again to try to get everybody to agree how awful the NHS is. Once again, it will be a struggle to fill that in in south Yorkshire. None the less, although that press release says that almost 20,000 jobs have been lost from the national health service, the motion does not do soit refers to posts. All of us who want to share the truth about such matters know that nowhere near 20,000 jobs are being lost in the national health servicenot in the last 12 months, two years, three years or anything else. There are more than 80,000 additional nursing jobs in comparison with 10 years ago, and many other grades have more people working in them.
	We received an e-mail from NHS Employers alluding to this matter, some of which was quoted by the hon. Member for South Cambridgeshire. That e-mail stated:
	Last week, NHS Employers contacted 18 trusts which had identified potential redundancies. Across all the organisations, the original estimate of the number of posts to be lost was 7,900, with the DTI subsequently notified of 3,999 jobs at risk. The number of actual redundancies (voluntary and compulsory) is 766. Of these 540 are in two organisations[ Interruption .]
	I will go on, because the hon. Member for South Cambridgeshire missed all that outclearly, he just picked up the second page when it came out of his printer. The document continued:
	The figures being widely quoted of up to 20,000 may turn out to be not too far off the total reduction in workforce numbers this year. This applies, however, not to people being made redundant but to the number of posts being taken out of the system in a total workforce of some 1.3 million which experienced an increase of 268,000 during the previous six years.
	That has not stopped the Conservatives saying in their petition to councils that there have been 20,000 job losses in the national health service. I shall ask my party if it will produce a motion for our councillors to take to their council chambers, which says that those are not job losses in the real sense.

Graham Stuart: They are.

Kevin Barron: I note what the hon. Gentleman says from a sedentary position. The Conservative motion alludes to nurses in training who will not be able to get jobs, as was reported on the front page of my local newspaper earlier this year about those who do their practical work in Rotherham and then go to the medical school in Sheffield for nurse training. But what happened to them? They all got jobs. The only redundancies made at Rotherham district general hospital this year were three compulsory redundancies among administrative staff. To read the local press, one would have believed that hundreds of staff at our local district general hospital would be out of work.

Stephen Dorrell: If the University Hospitals of Leicester NHS Trust employs fewer people next year than this year, I call that job losses. What does the right hon. Gentleman call it?

Kevin Barron: In my view, posts unfilled are not job losses. When the right hon. Gentleman was Secretary of State, I accept that there were job losses throughout the national health service. Unfilled posts, however, are not people being made redundant or people being added to unemployment statistics in this country; they are merely jobs not filled.
	If Conservative Members want to listen, the Health Committee currently has two ongoing inquiries, one of which is on deficits, which we are trying to bottom. My voice is going hoarse from talking to organisations such as the Royal College of Nurses, which keeps saying to the media that there are hundreds if not thousands of job losses. I keep asking it to send me the evidence of people being made redundant from the national health service. I said that months ago, and again two weeks ago, and the evidence has still not arrived The inquiries on both deficits and work force planning are still ongoing, and as Chairman, I and other Committee members would be more than happy to receive that evidence if it exists. Putting out press releases about the work force that do not represent the reality on the ground does no one any good in this debate.

Martin Horwood: One of the problems for the Royal College of Nursing and the Royal College of Midwives is that they cannot extract the numbers from local NHS trusts and hospitals, or from the Department of Health. Surely the right hon. Gentleman should expect the Department to provide the numbers, not the RCN.

Kevin Barron: We are doing that, and we are asking witnesses. I did not have any difficulty finding out what is happening in my local health community, in the primary and acute sectors. Together with other Members who represent constituencies in the Rotherham borough, I have annual meetings on the issue. The reality is that this year there are three redundancies of administrative staff.

Andy Burnham: As a Yorkshire MP, my right hon. Friend may wish to comment on annex E of the Conservative campaign pack, which has a list of job losses, as they are called. It claims that 1,100 jobs will be lost in the Mid Yorkshire NHS trust. The information that the Department has is that although up to 400 jobs could be at risk, only six people will be made compulsorily redundantthough even six is too many. Does my right hon. Friend agree that the campaign pack includes such misleading information that it should be withdrawn immediately and not used as the basis for a national campaign this weekend?

Kevin Barron: Yes, I do, because it is wrong, false and misleading. This is no conversion to the national health service. They say on a Monday that they will not use the NHS as a political football and, before the ink is dry on that speech, they table a motion that does exactly that, with a campaign to be launched on Saturday morning. The people who work in the health service remember what happened between 1979 and 1997. Their memories are not as short as some people would believe. They know that the NHS has been a political football for far too long and they also know the improvements, for patients and the work force, that have taken place in the past few years.

Kenneth Clarke: When my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) began his excellent and thoughtful speech at the start of this debate, he was accompanied by the usual cacophony of noise that we hear in every debate we have on the health service, with people briefed by the Government Whips Office denouncing us for treating the health service as a political football. I find that recurrent atmosphere ever more remarkable, because we are steadily moving towards a consensus in principle on the health service, of a kind that I never thought I would live to see.
	We are all in agreement about the principles of the national health service. I have consistently believed that it should be provided free at the point of treatment, according to clinical need and largely funded out of taxation. The final loophole is only for prescription charges and so on, which we have always had in the system. I actually agree in principle with the reforms that the Government are introducing, because they are remarkably like the reforms that have been embarked on for the past 20 years.
	I was delighted to hear the hon. Member for Hackney, South and Shoreditch (Meg Hillier) give an explanation of how the health service has always been a partnership between the private sector and the public sector. Her views would have seen her drummed out of the Brownies 10 years ago if she had said anything of the kind from the Labour Benches. Her predecessor, who was a very left-wing Labour MP, has now joined the Liberal Democrats, who are the last defenders of the view of the old left opinion that provision by the state of the buildings, staff and everything else is a key part of the system.
	We are all embarked on what I never really thought was a market system, but has been called the internal market. It is a market-influenced approach, in which there will be a wider variety of suppliers, including the independent sector with the state-owned and provided hospitals, and in which patient choice is brought into play because it gives rise to competition and cost control and directs taxpayers' money to those places with greatest public demand because of the quality of service provided. In that way, the system reflects public need. That is our destination, but we are now in the middle of a familiar debate in which each side hurls at the other allegations about the acute crisis that we are in.
	My principal complaint about the Government is that having had their miraculous Pauline conversion about four years ago, they have so far embarked on the process of reform in such an incompetent fashion that they are in danger of giving it a very bad name. They are in the middle of a classic crisis of the sort that my right hon. Friend the Member for Charnwood (Mr. Dorrell) and I are only too familiar with. The Government do not even understand how they got there and they are in denial about the financial problems underlying the present situation.

Patrick Hall: Will the right hon. and learned Gentleman give way?

Kenneth Clarke: In a moment.
	I heard the Secretary of State using phrases that I remember using frequently when I was closing hospitals that we did not need. In my day, they were often Victorian workhouses. I would explain how we had to strive for more day surgery, shorter stays in hospital and more use of community services. That is all common sense when running any health care system. The snag is, as has been illustrated over and over, that that is not at the root of the present bad crisis. At the moment, many parts of the countryincluding mineare being driven to short-term expedients to address financial deficits. They are saving money wherever they can. The failure to offer jobs to physiotherapists has nothing to do with a movement towards a more rational service. Student nurses are having more difficulty finding jobs and clinical staff are being shed because the NHS is in a total shambles. If the Secretary of State will not acknowledge that, we do not have much chance of curing it. I preferred my hon. Friend's approach.
	The crisis is caused, as crises in health care systems throughout the world are caused, by a complete inability to control costs; the complete lack of a financial management system for most of the NHS; and an inability to localise the services sufficiently and give enough discretion to the people with the competence to sort them out, if that is what they wish to do.
	I accept that there is no shortage of resources. The tragedy is that the crisis has occurred after the Government have poured money into the NHS for the past 10 years. That is not a matter of pride. How can they have trebled the expenditure in cash terms and doubled it in real terms, but still need to sack staff or close hospitals all over the place because costs have not been controlled? The Government cannot answer that question.

Tom Levitt: I am grateful to the right hon. and learned Gentleman for reminding the House that we have trebled spending on the health service. Does he agree that in percentage terms this year's deficit is less than it was for several years under the Tories?

Kenneth Clarke: Well, I could retaliate with a list of the years in which we increased growth by 5 per cent. in real terms, but this is corny stuff. Expenditure on the health service has always gone up. We increased spending on health by 1 per cent. of GDP. Every developed country increases its spending on health care and, given today's demography, will continue to do so. It is corny nonsense to say, Aha, the Conservatives spent less than we did.
	I would point out that the rate of increase of recent years cannot be maintained. A fundamental spending review is on its way and it will be impossible to maintain 7 per cent. real-terms growth in health spending, without doing fantastic things to the budget of every other part of the public sector. The public spending review towards which the Government are just beginning painfully to creep cannot maintain that rate of growth. It will shrink, and the failure to tackle the present problems will produce more crises, unless the Government face up to the fact that they are going nowhere fast. They must face the fact that just spending money has not delivered what they wanted and expected.
	Where has all the money gone? It has gone in costs, includingas it is bound to do in a health care systempayroll costs. Of course, there have been improvements. It would have been impossible to spend all that money without seeing some improvements, but the health service has always improved, year on year, ever since it was created. People cite the problems in 1997, but I say that they should have seen what it was like in 1979. Those are hopeless historic comparisons.
	The health service has got better, but most of the money has gone on enormous payroll increases and pay rises for the staff, on a scale that has not been matched by increased activity. The productivity performance of the health service has, as everybody has pointed out, steadily deteriorated. If one thinks that the health service is important, that is no way to run it. Ministers take pride in the 300,000 extra staff employed in the NHS, but what do they cost?

Andy Burnham: Will the right hon. and learned Gentleman give way?

Kenneth Clarke: No, as I am afraid that I have a time limit.
	The NHS is the largest employer in western Europe, but Ministers must resist the temptation to make political claims about how many new jobs are being created. They must have regard to what the extra staff are being employed to do, whether they can be afforded, and how the system is being allowed to proceed.
	In my day, pay negotiations were very difficult. Ministers of State used to have to get stuck in, because no one on either side of the House could be persuaded that the affordability of pay increases was something that had to be borne in mind. What has happened since then? The working time directive has been allowed to go through, and there has been a huge increase in the number of doctors. The 24-hour commitment of GPs has been abolished, and all nursing grades have been raised as a result of people writing their own descriptions of their responsibilities. Lots of other staff are now employed, and we have the best paid clinical professions in western Europe. I congratulate the BMA and the RCN: as usual, they have taken the Department of Health to the cleaners, but what were Ministers doing when all that was happening?
	The NHS has no system of proper financial control. We all believe in a giant NHS run on principles that everyone accepts, but there must be a system of financial control. All other giant organisationssuch as Marks and Spencer and BP, although they are smaller than the NHShave that. I can think of no other business-like activity whose first thought is to cut back its service, or product. The health service goes running around closing wards because it cannot afford the staff to keep them open. It closes community hospitals and stops recruiting the necessary trainee staff, but none of those problems has been addressed.
	Of course, those are not comfortable things for me to say. I might have to mute some of it at the next election, as the news that not all problems will be solved merely by getting rid of the present Government is not always welcome to a general audience. However, my hon. Friend the Member for South Cambridgeshire is trying to depoliticise and localise the argument, and that approach is absolutely essential.
	The only way to manage the NHS is through more, and genuine, local budgeting and financial control. People will have to stick to their local budgets, but they will have discretion about how they spend the money. We are getting GP fundholders back, but I have yet to discover whether they will have real budgets and total discretion over where they spend their patients' money in the service. All that has to be tackled, but what we do not need is more mad structural change all the time.
	The Government have failed to manage the changes that their reforms requireof course the pattern of service has to change, but they are not even controlling the pace of change. It is crazy to go backwards and forwards on PCTs, commissioning, budgeting and so on, because that just demoralises the people who should control things. That is a failure on the Government's part. They are in a crisis, and they need to start again and decide how they are going to reform the NHS.

Neil Turner: I begin by declaring an interest, in that my wife is a member of the Wigan and Leigh hospital trust board. I am amazed at the brass neck displayed by Opposition Members in holding a debate on the NHS. They seem to forget some of the problems that existed in 1997. They do not like to hear what they were, but it is important to put what is happening in context.
	I remember workers throughout the country holding a one-day strike to support nurses, who did not want to go on strike and therefore disrupt the services that they were providing. Other workers were prepared to give up a day's work to support the nurses, to whom the then Conservative Government did not want to pay a proper wage.
	I also recall the winter beds crises that arose year after year. Patients were forced to use trolleys in hospital corridors or were bused all over the country in ambulances. People were even treated in ambulances in those days, but such things do not happen now.
	Two years was the norm for waiting lists throughout the country in 1997, but nowadays the maximum wait in Wigan in six months, and the vast majority of cases are dealt with in three months or less. I remember having to wait in an accident and emergency department in Wigan for more than eight hours before I was seen, but every patient is now dealt with inside a maximum of four hours.
	All that represents a dramatic change from what was happening in 1997, and it would have been nice to hear an apology from Opposition Members for that. Given where the Leader of the Opposition was on Black Wednesday, I suppose we should expect him to say, Je ne regrette rien. However, instead of saying, We regret nothing, what we get is the Opposition saying, We forget everything. Well, neither I nor the people of Wigan have forgotten, and we will make sure that the people of Britain do not forget when the next election comes around.
	What are the Opposition's policies now? In 2005, as we have heard, we had the patient passport, which would have put wads of money into the private sector. In 2006, we have the Leader of the Opposition on his webcam telling us how good it is to wash up dishes, although I not sure what that says about him. The Conservative spokesperson on health says that his party does not want any more reorganisation, but that there will be a new organisation to reorganise things. He also says that there will be no more targets, but that his party will introduce protocols instead. The Opposition are all over the place: we have gone from flog it to blog it to blag it, but not one Conservative Member has shown any sign of embarrassment.
	I want to tell the House what is happening in Wigan. The Wigan PCT and acute hospital trust covers Wigan and the constituencies of Makerfield and of Leigh, and parts of Worsley and West Lancashire. I am sure that my right hon. and hon. Friends who represent those areasand they are friends as well as parliamentary colleagueswill not mind too much if I stray into their territories.
	Since 1979, we have some 400 extra nurses and 100 extra doctors in Wigan. In the past two years, we have recruited 20 extra GPs, and 14 extra matrons are working in the community. Just as importantly, huge capital investment has been made. There are new maternity, neonatal and intensive care units at the Royal Albert and Edward infirmary, as well as a new X-ray department with a magnetic resonance imaging facility. The hospital has a new endoscopy unit, and extra beds. In case some of what I have listed does not work, the hospital also has a new mortuary.
	At the Wrightington hospital in the Wigan areawhere hip replacements were originally pioneeredthere are two new clean-air orthopaedic clinics, while other wards have been refurbished and upgraded. Moreover, the Thomas Linacre centre is a brand-new outpatient facility in the centre of the town.
	Over the recess, I visited the new cardiac catheter laboratory that has opened in the Royal Albert and Edward infirmary, and the new patients information centre at Wrightington. I also went to the renal unit opened under Wigan's LIFTlocal improvement finance trustprogramme. Never has one so well gone to so many health units in so short a time.

Grant Shapps: We are all delighted for the hon. Gentleman's constituents in Wigan, but how does he think that my constituents in Hertfordshire will feel? They were promised a hospital worth 500 million before the election, when a health Minister represented the seat that I now occupy, but the hospital has been withdrawn now that the election has passed. I understand the party political points that he makes, but how does he explain the fact that 18 years of so-called Tory cuts in the NHS meant that my constituency had the QE2 hospital, with accident and emergency, maternity, paediatric and other services? They have all been stripped away. The news is good for people who happen to live in Labour constituencies, but blooming bad for those who did not vote Labour. The Government's policies are a punishment, are they not?

Tom Levitt: QED.

Neil Turner: That is exactly my point: what happened in those 18 years is that we were not getting the service improvements that we needed, because you were gerrymandering so much of the money into your own areas. We have a new system now, in which money follows the needs of patients. What you have to ask your people

Mr. Deputy Speaker: Order. I think that the hon. Gentleman knows what I was about to say.

Neil Turner: I apologise, Mr. Deputy Speaker. The hon. Gentleman should ask why his PCT is getting more money than the formula prescribes. Why does it get extra money through the market forces factor, yet remain incapable of running its service properly? In contrast, my PCT is underfunded under the formula and gets less money through the market forces factor, yet is able to budget properly. Our PCT is three star, and we also have a three-star hospital. They keep to their budgets. If the hon. Gentleman cannot make sure that his PCT keeps to its budget, that is a matter for him.
	The cardiac catheter laboratory makes sure that there is early diagnosis of heart trouble so that people can be treated and kept out of hospital. The patient information centre makes sure that patients who go for difficult operations understand what is going on. In that extremely anxious period, they will be given the kind of reassurances that they want. The renal unit means that, instead of patients trawling all over Greater Manchester looking for somewhere to have kidney dialysis, they can now have that treatment in the centre of Wigan. That takes an incredible amount of stress off not just the patient, but the families and friends who have to drive them there.
	Those last points illustrate the huge changes that are being made and that need to be made if we are going to deliver health care properly in this country. I am talking about a massive shift from secondary to primary care. The Minister of State, Department of Health, my hon. Friend the Member for Leigh (Andy Burnham) will know of the doctors surgeries in two-ups and two-downs in Leigh, and up and down the Wigan area. They provided a poor service, not because the doctors were bad, but because the facilities were. In Wigan, we now have a refurbished clinic at Tyldesley and new clinics at Atherton, Ince, Worsley Mesnes, and Golborne. Platt Bridge is being built. Pemberton is being extended. More clinics are planned at Standish, Shevington, Whelley, Wigan, Ashton and Leighall with a huge range of facilities and with brand new treatments. What is the result of that? As I said, there is local delivery of renal care.

John Bercow: The hon. Gentleman is positively triumphalist about the position in Wigan, but how does he explain the contradiction between the fact of greatly increasing expenditure nation wide on the one hand and no comparable increase in national health service productivity on the other?

Neil Turner: I am not a statistician, but I suspect that one of the problems is that if a lot of money is put into making sure that people do not get ill, the productivity endthat is to say, the measurement of how many people are treated and how they are treatedwill be difficult, because the reality is that one makes sure that people do not get ill and that means that one is less productive. That is nonsense. There needs to be a way to look at the statistics to make sure that they properly reflect what is going in.

Nicholas Soames: Jolly good try.

Neil Turner: Thank you. I thought that it was fairly successful, as well.
	Not only do we have renal units, but diabetes is being treated in the community. People who have heart disease are being treated in their own homes, although obviously not while they are having their operationI would not suggest that for one minute. The post and pre-operative aspects are being dealt with in people's own homes. Cancer therapy is being delivered at home. There are smoking cessation clinics in the clinics that I mentioned. In the case of dental treatment, there is an emergency line that operates 24/7 for the whole of the borough. That shows a shift from secondary care to primary care when dealing with health. It is not just a matter of some kind of organisational shift; it is what patients need and want, and what we are delivering.
	I will finishI am well aware that many people want to speak in the debateby giving my constituents a strong warning. What we heard from a number of Members, and particularly the hon. Member for Northavon (Steve Webb) and others who talked about the campaign pack from the Conservatives, was that that pack provides a stark warning. The Conservatives will move resources from Wigan to Windsor, from South Kirklees to south Cambridgeshire, and from Leicester to Leominsterfrom places that need those resources, because health there is poorer, to places that do not need them, because health there is better. Resources will no longer be based on health needs. They will be gerrymandered yet again to Tory areas. If anybody in Wigan votes for the Conservative party at the next election, they should know what they are voting for.

Stephen Dorrell: I want to respond briefly to the point with which the hon. Gentleman closed. It has been apparent several times in the course of the debate, listening to Members on the Front Bench, as well as the Back Benches, that the charge now being levelled against the announcements that were made by my right hon. Friend the Leader of the Opposition on Monday is that they represent at attempt to gerrymander resources. The truth is precisely the opposite. The announcements are a response to the Government's gerrymandering of resources. We seek to set up an established authoritative body that can provide an independent assessment of where health resources ought to go. We want to do that in order to ensure that the national health service is in a position to deliver the objective that my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) made clear is shared explicitly right across the House: we want to have a largely tax-funded health care system that is available to people on the basis on needon the principle of equitable access to those who need it, without regard to ability to pay. Attempts by Labour Members to undermine, or eliminate, that political consensus across the House are doomed to fail. I want to return to some of those themes in a moment.
	I congratulate my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) on the fact that he has focused the debate on the key resource of the national health service. The message coming back right across the health service is that, although Ministers repeatedly say that the delivery of health care depends on the professionalism and commitment of health service staff, which we all know to be true, the message that is received by national health service staff themselves is that their professionalism and their commitment to the service is being systematically undervalued by the Government who are supposed to be their employer. Staff feel that their commitment is undervalued becausedespite the huge increase in resources committed to the health service, which commands support right across the Housethey find themselves in the too familiar situation of being caught up in the management of short-term crises that are repeating themselves right through the national health service. In any organisation, when people find themselves responding to firefighting initiatives and short-term crisis management measures, that undermines morale and that is precisely what is happening right through the national health service today.
	Like my right hon. and learned Friend the Member for Rushcliffe, I think that it is fundamental that we understand why that situation has arisen despite the huge increase in resources committed to the national health service. I was struck by the fact that the Secretary of State was lecturing the House from the Dispatch Box on the importance of Ministers and managers in the national health service facing hard truths about the requirement to use resources efficiently if the health service is to deliver its objective of equitable access to high quality health care. As my right hon. and learned Friend said, he has made that speech, as have Ievery Secretary of State for Health has made it. The problem is that this generation of Ministers had a once-in-a-lifetime opportunity to use resources to address some of those fundamental problems of efficiency in health care delivery in the health service and they fluffed it. They had an opportunity that was not available to my right hon. and learned Friend when he was Secretary of State for Health and that he made certain, when he was Chancellor, was not available to me when I was Secretary of State for Healthan opportunity to use that huge increase in resources to oil the wheels of change. The present Government had the opportunity to use those resources to provide a step change in the efficiency and quality of service that is being delivered by the health service. The present generation of Ministers has missed that opportunity and the result is that we are back with short-term responses and crisis management.
	Let me give the House three specific examples of what that means in practice for people who deliver care to patients on a day-by-day basis, rather than make speeches about the health service. First, we have what are often called in health service-speak the priority services. There is an unintended irony in that phrase. I am talking about community services, therapies and the low-tech services that are delivered at community level that often bring a quite disproportionate benefit to the quality of life of patients. However, they are the easy targets every time a health service manager faces the need to make short-term cuts so that the books can be balanced. That is why we have unemployed physiotherapists throughout the countrythe health service cannot afford to employ themwhy occupational therapists are looking for jobs and why social services are complaining about their inability to get local partnership arrangements out of the health service.
	The effect of such short-term cuts in community-based services throughout the health service is twofold. First, they undermine morale because those who are delivering the service know that it is not as good as it could be. Secondly, and absurdly, they mean that we are building up long-term costs in the health service because people are being trapped in hospital, rather than released to properly funded and resourced community services.

David Burrowes: Will my right hon. Friend add to his concerns the example from my constituency of the effective cuts that have led to unfilled health visitor posts and caused the closure of baby clinics and the suspension of routine developmental checks? That, together with the danger that our children and maternity services will be transferred, has led to profound concern that services are being hit where it hurts most. We have the agenda for Every Child Matters, but that certainly does not matter in Enfield, Southgate.

Stephen Dorrell: My hon. Friend is entirely right. He cites a perfect example of the trend about which I am talking, which exists throughout the health service. Resources are being taken out of the community services because they are an easy hit.
	The second example of short-term crisis management is the difference between the rate of inflation of health care costs in the system and the change that the Government have made to the tariff charged by secondary care to PCTs and commissioners. We all know that health care costs are rising very quicklymy right hon. and learned Friend the Member for Rushcliffe referred to thatand the latest estimate from the Office for National Statistics, which was published in August, is that they are rising by 6 per cent. a year. Given that the costs are rising at such a rate and the tariff that the Government published on 26 January increased by 1.5 per cent. a year, one does not need to be a statistician to work out that that represents a 4.5 per cent. cut in the real resources available for the delivery of individual procedures by NHS providers.
	The situation shows that Ministers are not facing up to the consequences of their actions. If costs are rising by 6 per cent., yet Ministers fund them to the tune of 1.5 per cent., Ministers are effectively hoping that all the people in the national health service will somehow cover up the 4.5 per cent. gap so that they can avoid political embarrassment. It is not surprising that those people find their morale undermined if Ministers apparently believe that they are employed to do such a job. Those people think that they are employed to deliver high-quality health care to patients, as they should be. However, their experience is one of being asked to cover up the consequences of ministerial unwillingness to face precisely the kind of tough decisions about which the Secretary of State talked.
	The development of training policy in the NHS, which is my third example of the short-term responses, has already been referred to during the debate. I have previously welcomed in the House the fact that we now spend more on training doctors and nurses in medical and nursing schools than we did when I was Secretary of State. I have reminded Ministers on previous occasions that that has happened partly because of carrying through plans that started to be generated when I was Secretary of State, but the big increase is welcome. However, it is not welcome that people who leave medical schools, and especially nursing schools, find that they cannot be employed in the national health service because Ministers have not faced up to the need to improve the efficiency with which health care is delivered. Furthermore, not only do we have unemployed nurses and doctors coming out of the growing medical and nursing schools, but the operators of the schools anticipate a 10 per cent. cut in the budgets available for training future doctors and nurses for the national health service. The Government have created a growing training sector, but they are not employing the people whom it produces, and they are also preparing a substantial cut to the increased training budget for which they are claiming credit.

John Bercow: Of course, that is true not only of doctors and nurses. Is it not particularly absurd that whereas there is a substantial increase in the number of trained and qualified speech and language therapists, there is also a substantial increase in the unmet need among children who require the service, but for whom the employed personnel to provide it do not exist?

Stephen Dorrell: My hon. Friend is right. Why does that undermine morale? It is partly because it results in unemployed people with training that they want to use and partly because the people in the service know better than the politicians the impact of the failures on the service delivered to patients from day to day. They can compare that service with what they want to deliver and what they know could be delivered if only the health service was led in a way that faced up to the real choices about which the Secretary of State likes to talk.
	I agree with the Secretary of State when she talks about the importance of facing hard choices to deliver real improvements in health care. However, I look for a Minister who not only talks the talk, but walks the walk. I want to link the situation to the seven or eight rounds of bureaucratic change that we have had in the health service since 1997. The Government have brought us back round to virtually the same point at which they started nine years ago. Not only has that process led to a huge waste of resourcesI have seen estimates suggesting that the whole rigmarole has cost roughly 1 billionbut more fundamentally and importantly, it has meant that the kaleidoscope of changing management structures simply has not addressed the real choices about which the Secretary of State has talked. That is the link between the bureaucratic changes for which the Government are responsible and their fundamental failure to deliver improvements in health care, which is what hon. Members on both sides of the House want.

Gordon Prentice: The Member for Rushcliffe (Mr. Clarke) gently mocked Labour Members for hyperventilating when it comes to the Conservative record of all those years ago. I agree with him that policy convergence is taking place. In fact, the Prime Minister is on record as saying that a lot of policy cross-dressing is going on, yet we have these debates that are full of sound and fury about what the Conservatives did in their 18 years, and I think that it is just a big yawn.
	The Prime Minister can be very tribal. At Monday's meeting of the parliamentary Labour party, he told usjacket off; gleaming white shirtThe Conservatives have a marketisation agenda, you know. Get in there on Wednesday. Goodness me, I thought. I will come on to the business of new Labour and the market in a minute.
	I also wanted to pick up on the point made about structural change, which has been hugely debilitating. In the time that I have been a Member of Parliament, strategic health authorities have changed massively. We have a huge strategic health authority in the north-west. In east Lancashire, which is where my constituency is, East Lancashire health authority morphed into Burnley, Pendle and Rossendale primary care trust, which has morphed into an even bigger PCT. We had two hospital trustsBurnley hospital trust and Blackburn hospital trustbut they have been merged. The Lancashire ambulance service has been abolished and we now have a regional ambulance service. Community health councils have been abolished and we now have public and patient involvement forums, which are about to be abolished and replaced by patient links.

Tony Baldry: Is it not especially tragic that while we started off with community health councils that people understood, no one now understands how patients or the general public have a voice in NHS change?

Gordon Prentice: I agree entirely. Last year, there was a lunatic proposal from Lord Warner to transfer 250,000 people directly employed by primary care trusts from the NHS into the private, voluntary and not-for-profit sectors. That was stopped only because of the huge outcry from Labour Members. The announcement was made on 28 July, and it was finally overturned by my friend the Secretary of State last November.
	Debilitating change has taken place. The Prime Minister tells us that we are the change makers, but every time that we change the organisation, it is set back a year, or perhaps 18 months. It takes time to recover, and as soon as it has recovered, we slap it in the face again and reorganise. The way in which we endlessly reorganise the health service is Maoist, which is why people in the health service are so antagonistic towards us, why the platform lost an important conference motion moved by Unison in Manchester, and why a statement by the national executive committee, saying that more work had to be done to engage people working in the health service, was rejected by the conference. We regard people working in the health service as pawns that can be moved about, but they are finally saying, No, we are not having it.
	The private sector is moving into the health service in a big way, but that is being done surreptitiously. Ministers do not say that it is taking place, although they should do so. All the arguments are wrapped up in issues such as contestability; instead, we should just play it with a straight bat and say, There are too many people sleeping at their desks in the national health service; we will put 20,000 volts through the NHS and bring in the private sector.
	That is what is happening in my constituency, where Netcare, a South African firm, has become involved. I have a letter from my primary care trust that reminds me that Netcare runs a local mobile ophthalmology unit at Rossendale hospital, but I am told that Netcare is coming to Lancashire in a big way. The contract will be signed by the end of the year. I am told that Netcare services
	will be established in the following specialities
	I thought that it would just deal with the odd cataract, so that we process ophthalmology patients quickly, but it will be involved in work on ear, nose and throat, general surgery, trauma, orthopaedics and rheumatology. Urology and gynaecology, too, may be included, which does not leave much. Let us not kid people outside. The Prime Minister and the Government have a pro-market agenda, and they are pursuing it.

Meg Hillier: Does my hon. Friend agree that although the vast majority of NHS services in this country are provided in NHS facilities by NHS-employed staff, there are examples of cases in which it is not the best provider? I can give a personal example of a family member who was waiting for a wheelchair. She received it free at the point of delivery, but it was made by a private company, and private companies undertook the fitting. She was glad to receive the wheelchair. Is my hon. Friend suggesting that the NHS should open a wheelchair factory and make all the component parts, and provide the wheelchairs as well as the free service at the point of delivery?

Gordon Prentice: That is the argument about NHS Logistics. We can deconstruct organisations such as the police service. One might say that police officers should be fighting crime, not patrolling motorways, so we should take that responsibility away from them. The same could apply to the national health service. There are many people who want to be in the national health service family, and I agree that they should be part of it.

John Pugh: Were service users consulted about the change in the ophthalmology department?

Gordon Prentice: I very much doubt it, because there are no consultation procedures when services are moved from the NHS into the private sector. There was no consultationit just happened. I got my information from the PCT; I did not have an opportunity to say that I do not want Netcare to be responsibly for urology, gynaecology, and ear, nose and throat procedures. I do not want that South African company to be responsible, but I was not asked, and nor was anyone else.

Patrick Hall: Will my hon. Friend give way?

Gordon Prentice: You are on my time.

Patrick Hall: I shall be brief. May I give my hon. Friend an opportunity to return to his characteristic loyalty to the Government by at least agreeing that the difference between the Conservative and Labour parties is that we do not pretend that we can grow the NHS while cutting tax?

Gordon Prentice: I would prefer to return to my own agenda in the five minutes left to me.
	I am glad that my friend the Member for Burnley (Kitty Ussher) is here, because the latest shock to the system is that we may be losing the blue-light accident and emergency department at Burnley general hospital, which serves my Pendle constituency, too. Those services may be moved to Blackburn on the other side of east Lancashire. I do not believe that a proposal to close the blue-light accident and emergency services in Blackburn and transfer them to my friend's constituency would see the light of day. Tomorrow, the council's overview and scrutiny committee will make a decision on whether or not to refer the issue to the Secretary of State for Health. My friend and I are against it, the patient and public involvement forum is against it, general practitioners and others in the medical community are against it, and local people are against it, yet there is a possibility that tomorrow the overview and scrutiny committee may not recognise the strength of public opinion. That is why my friend and I will go up to Blackburn to speak to that committee, regardless of what the Whip says here.  [Interruption.] I am speaking for my friend, and I think that I am doing so very well.
	The issue of ambulance times is critical. In my PCT area, it takes an average of 38.57 minutes to take someone to the nearest accident and emergency department. In West Craven, where I live, it takes 54.48 minutes, and that is before the possible closure of blue-light accident and emergency services in Burnley. The ambulance will shoot past Burnley general hospital to reach Blackburn, way over the horizon.

Neil Turner: On the motorway.

Gordon Prentice: Indeed, it is an absurdity. I do not know how many times I have driven down the M65 only to find the junction for Blackburn clogged with traffic.

Ian Austin: Will my hon. Friend give way?

Gordon Prentice: No, I will not.
	We hear from Ministers all the time about the need to listen to peoplewe heard about it today from the Prime Minister and from the Secretary of Stateand if decisions on the NHS are to be made locally, the overview and scrutiny committee ought to listen to their voice.

Ian Austin: rose

Gordon Prentice: Would my friend like to intervene?

Ian Austin: I am grateful that, finally, my hon. Friend has allowed me to intervene. I would like to ask him whether anything that the Government have done since 1997 has been welcomed by the people of Pendle and whether he can present a rather more balanced picture. Does he welcome the extra resources that have gone into the NHS in his constituency, and does he welcome the increased number of people who have been treated there? Does he welcome the financial position in his constituency, as I understand that both the hospital trust and the PCT have a surplus?

Gordon Prentice: My friend has abused the generosity that I demonstrated when I allowed him to intervene. There are plenty of opportunities for balanced discussion at the meetings of the parliamentary Labour party. I am trying to save my local accident and emergency department, as the decision will be made tomorrow.
	The overview and scrutiny committee reports to my friend the Secretary of State, who has the power to refer the proposal to the independent reconfiguration panel, which consists of independent clinicians from across the United Kingdom who do not know east Lancashire. If they say that the department has to be closedI say this to my friend the Member for Wigan (Mr. Turner), who takes great delight in interrupting me all the timewe can live with that, because independent clinicians will have made that recommendation, not the director of accident and emergency services, who will speak at the overview and scrutiny committee minutes before the councillors are invited to make a decision.
	There have been 13 recommendations from overview and scrutiny committees to the Secretary of State but she has passed only two of them on to the independent reconfiguration panel; that is not good enough. I had a meeting yesterday with Dr. Peter Barrett, who chairs the independent reconfiguration panel, and I told him that I hoped that there would be a reference through the overview and scrutiny committee to the Secretary of State, and that she would not throw it in the wastepaper basket, but that she would pass it on to that panel, which we on the Labour Benches set up to make recommendations that would carry public confidencein this case in my constituency and the neighbouring constituency of my friend the Member for Burnley.

Michael Mates: It is often what happens to individuals, rather than what happens to institutions, that tells us when something is going badly wrong. Over the past two years, I have read with mounting disbelief letters from my constituents about the NHS in Hampshire. In case after case, they complain that they cannot get the treatment that they need. They tell me that national policies, such as cancer treatment within four weeks of diagnosis or the provision of services in community hospitals, are not being delivered on the ground.
	When I take up these problems with the relevant authorities, I am sent from one to another, on a bewildering journey around an amazing merry-go-round of bureaucracies, none of whom seems to be wholly responsible for what has happened. Is it the hospital trust that is responsible, or the primary care trust, or the National Institute for Health and Clinical Excellenceor even, perhaps, the ambulance service? The space between the various bodies is not so much a gap as a swamp into which my queries sink into boggy depths, with all too often no satisfactory explanation for what has gone wrong.
	Let me say something elseby way of light relief, perhaps. The new Hampshire strategic health authority started on 1 October. Its chief executive was the chief executive of one of the major trusts in the county; he has moved up the ladder, as so often happens in such situations, and I do not knock him for that. However, when I wrote to him about a problem at the beginning of September, he repliedvery promptlythat he could not help me until 1 October because he did not exist until then. Such bureaucratic problems make a bad situation even worse.
	Only yesterday, I received a letter from a constituent whose wife was diagnosed with a brain tumour on 9 June at Queen Alexandra hospital in Portsmouth, and it is that that has prompted me to take part in a health debate, which I do only very infrequently. Despite continuing pressure from her husband and her GP, no treatment began within the target time of four weeks. Indeed, they had to wait nine weeks for treatment at the other hospital in Portsmouth, St. Mary's. During the intervening period, her condition deteriorated, so that in the end radiotherapy treatment was too much for her to bear and had to be stopped. She died six weeks later.
	Why did she not receive treatment within the stated time? I shall seek an explanation from the two hospitals involved. One of the things that my constituent simply cannot believe is that it takes two weeks for medical records to travel the two miles from one hospital to the other, because they are sent by second-class post.
	But it is not just in headline grabbing areas such as cancer treatment that the NHS has problems. The Government say that they are committed to community hospitals, but both of the community hospitals in my constituency have experienced significant service reductions at a time when, as everybody agrees, the NHS budget has been expanding. At the Alton community hospital, the Inwood ward was closed for many months. Happily, it will now reopen. At Petersfield hospital, the Grange maternity suite was closed at two weeks' notice because of staff shortages, and it has stayed closed for 16 months. Happily, that is also now reopening. But how could the planning go so awry that those closures were necessary in the first place?
	The trouble is that the NHSparticularly in Hampshireis suffering from a stop-go policy. Sudden staff shortages or budget crises cause the withdrawal of a service. That sets off an understandable public row. Health service managers promise to reopen the facility, but are vague about when that will happen. After many monthsoften over a yearit is necessary to launch a recruitment drive to find the staff to run the service so that it can be reopened. Meanwhile, other parts of the NHS are making people redundant. The facility then reopens, but oftenas at Petersfieldwith a reduction in services.
	That stop-go approach is deeply debilitating. It undermines morale in the NHS, wastes resources as facilities have to be closed and then reopened, and, worst of all, it bewilders patients. It is the most vulnerable patients who suffer from the closure of community hospital facilities, as they are the ones who are unable to travel to the nearest district general hospital.
	This mismanagementthat is what it isresults from the total absence of stability within the service, as my right hon. and hon. Friends, whose knowledge is greater than mine, have mentioned. When my right hon. Friend the Leader of the Opposition spoke about taking politicians out of the NHS, he did not mean for us to walk away from our ultimate responsibility to provide health care; he meant that the constant chopping and changing brought about by the pressure of party politics has to stop.
	Somebody said that there have been seven reorganisations of NHS bureaucracy since 1997, but I make it 10. I am not trying to dismiss the value of managersgood managers save lives by making the best use of inevitably limited resourcesbut it is no good Ministers trying to pretend that constant changes in management and structures do not adversely affect patients, because they do. An estimated 320 million is being spent on the current reorganisation of PCTs, and many of my constituents want to know why that money is not being spent on patient care.
	Another constituent of mine has kidney cancer, and his consultant at Southampton general hospital wants to treat him with a new drug called Sunitinib. Clinical trials of the drug have been conducted for about six months and it has proved extraordinarily effective, to the extent that another of my constituentsa 38-year-old womanis back home with her family. Yet before the trials began, it was thought that she had only weeks to live.
	My constituent's kidney cancer was diagnosed two days after the trials officially ended, and although the treatment has been proven to be highly effective, it is not available any more, the argument being that it has not been approved by NICE. Indeed, according to a written answer in June from the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham), the Department of Health is still deciding whether to refer the drug to NICE for consideration. When I asked about this, Lord Warner replied that it was for hospitals and PCTs to decide whether to prescribe new treatments. He went further, saying that
	PCTs cannot refuse to fund drugs simply because NICE guidance is not available.
	He added that PCTs
	should not refuse to fund treatment solely on the grounds of cost but should consider all the circumstances before making a decision.
	So what is the problem? The drug is the treatment of choice of the consultant, who is thrilled with the success of the trials. It is available, but it is not allowed to be prescribed and my constituent cannot have it.
	The reality is that health rationing is going on all over Britain, and it is a complete lottery as to whether a particular treatment is available in a particular area. That does not add up to a national health service. I do not doubt the personal commitment of Ministers to solving some of the problems, but they do not seem to recognise that it is their making constant changes, the expansion in the number of managers and the obsession with targets that is denying patients the choice that they should properly have. If the focus of the national health service should be on anything, it should be on nothing more than patient care.

Ian Austin: I want to thank the Opposition for calling this debate, although the picture of the NHS painted by the hon. Member for South Cambridgeshire (Mr. Lansley) is not one that my constituents would recognise. Investment has doubled nationally since 1997, and it will treble by 2008. There are 32,000 more doctors and 85,000 more nurses, and by 2010 there will be 100 new hospitals. As you know only too well, Madam Deputy Speaker, my constituency has a brand new hospital that is treating more of your and my constituents more quickly than ever before. The real reason, however, why I welcome today's debate is that it gives us the opportunity to show that when it comes to the NHS work force and service development, the only party that can be trusted is ours. Whatever they may say in their motion on today's Order Paper, the Opposition still do not believe in the NHS.
	Last week, we were told by the Leader of the Opposition how much he now cares about the health service. This remarkable conversion follows earlier eye-catching statements in which he said, for example, that he is not a Thatcherite and that he now cares about poverty. He and his party have chosen change to win as their slogan, because they know that their brand was discredited and distrusted and associated with the failures and betrayals of the past. That is why they are trying to show that they now care about issues such as the NHS, on which they have never been trusted before. They might be doing a decent job on public relations, but they face much stricter testsvague claims about intent are not enough. I am not one of those people who say that the Tories believe in nothing and that they have no policiesquite the reverse. It is because of their beliefs and values that they cannot be trusted with the health service.
	The Opposition motion says that they want more staff, but the Leader of the Opposition says that the investment to pay for them is fiscal irresponsibility. He has committed his party to the so-called proceeds of growth rule, whichwhatever the Tories saycommits their party to cuts, year in, year out. As my right hon. Friend the Secretary of State said earlier, if the Tories were in power this year, the new rule would mean expenditure at a slower rate of growth than under the Government's plans. This year, the difference between the Opposition's plans and the Government's plans would be 17 billion, and it would be bigger in the future.
	NHS expenditure is almost a fifth of total managed expenditure, so a 17 billion cut in public spending applied across the board would mean cuts to the NHS of at least 3 billion this year[ Interruption.] The Tories may not like it

Graham Stuart: Will the hon. Gentleman give way?

Ian Austin: The hon. Gentleman can listen for a while. Let him listen to what the Leader of the Opposition said about the proceeds of growth rule this yearhis words, not mine. He said:
	As that money comes in let's share that between additional public spending and reductions in taxes. That is a dramatic difference. It would be dramatically different after five years of a Conservative Government.
	He also said that he wants to replace public services for the poor with
	a profound increase in voluntary and community support.
	It is the same old Conservative ideology: a small state and spending cuts, leaving the most vulnerable relying on charity. That is why the Tories cannot promise that they will not cut funding for the NHS.
	Before the Leader of the Opposition's conference speech last week, the Conservative party website said that it would promise:
	We will never jeopardise the NHS by cutting its funding.
	That line also appeared in the extracts released to the media before the right hon. Gentleman delivered the speech, but it did not appear in the final version or the published version.
	The Tory motion claims that the NHS is being cut, but the Opposition voted against the extra funds we invested. In fact, not only did the right hon. Gentleman oppose the national insurance increase at the time, he called for a social insurance system for health care instead. The Tories cannot say that they have changed that position, because only this week the shadow Secretary of State repeated his opposition to the tax increases that paid for the improvements. Time and again, they use moderate, compassionate language to mask traditional Tory positions.
	Today's Tories claim to support the NHS, yet they run it down at every opportunity. They tell us that they believe in the health service, yet they are still committed to massive cuts. They say the NHS is underfunded, yet they vote against extra spending. It is absolutely clear that when it comes to the health servicejust like everything elsethey do not have even one centre-ground policy.
	There is no huge secret about the so-called new Conservative party. Every speech makes it absolutely clear: the Tories may not spell out the lower taxes they want, or the precise parts of the so-called big state they want to cut down to size, but anyone who looks beyond the rebranding will see the same old Tories committed to the same old spending cuts. Instead of greeting their so-called changes with warm words of approval, we should expose the fact that they are not really changing anything at all. We should demonstrate that they will claim anything to win, but that they do not believe a word of it.

Grant Shapps: Much of what the hon. Gentleman says will ring hollow to my constituents and those of many Members on the Opposition Benches whose hospital servicesunlike those in Dudleyare being cut, not expanded. How can the hon. Gentleman stand in the Chamber and say things that are not a reality for the whole of the country?

Ian Austin: The reality for the whole of the country is that no one now waits longer than six months for an operation, down from 284,000 when we came to power. Ninety-nine per cent. of cancer patients are seen by a specialist within two weeks. Almost 99 per cent. of people with cancer are treated within 31 days of diagnosis, and 19 in 20 patients are seen, treated and discharged from accident and emergency departments within four hours.
	Those things did not happen by chance; they happened because we set targets to achieve them. Eradicating targets, as the Opposition propose, may sound alluring, but can they imagine a patient turning up at BUPAas they probably doand saying, I'll pay the charges and sign the contract but I don't care when you treat me, just do it in your own time. I don't want targets, I'm not that bothered? Of course not.
	It is not possible to say that everything is perfect in every case in the modern NHS, but no one prepared to look at the issues dispassionately can fail to deny that the NHS has been transformed. Come to Dudley and a brand new, 160 million hospital can be seen with more doctors, more nurses and more other staff treating more patients more quickly than ever before. There are new community facilities treating patients in their own homes in ways that could not have been dreamed of just a few years ago. That is not to deny that there are issues in Dudley. We have problems with car parking charges and we have a shortage of chiropodistsI hope that the Minister will help on thatbut the new facilities and low waiting lists in Dudley show the improvements that extra spending and modern ways of working can bring to the NHS.
	One does not have to accept my word on all that. Let me conclude by reading a letter from my constituent, Mr. Albert Williams, a 79-year-old gentleman suffering from two terminal illnesses. He wrote to the Secretary of State to say that
	the new hospital, the extra nurses and doctors and the new technologies I have seen at first hand have made a huge difference to me... The care that I have received in my home is a great example of the way the health service can treat people in the community, be visited by nurses, enabling them to live at home and free up hospital beds for other patients. Send people who spend their whole time complaining about our health service to talk to me. I can remember what people had to rely on before the NHS existed to treat people regardless of their income or ability to pay. It is our country's greatest invention and you,
	he wrote to the Secretary of State,
	should be proud of the work your government is doing to strengthen it for the future.
	That, Madam Deputy Speaker, is the truth about the modern NHS that the Government are building.

Nicholas Soames: First, I congratulate NHS staff in my constituency on delivering a wonderful service in a very good hospital. They are nervous and anxious about the future. I also warmly congratulate the shadow Secretary of State on the excellent way in which he moved the motion. I hope that the House listened carefully to the speeches of the two former Secretaries of State for Health, my right hon. Friend the Members for Charnwood (Mr. Dorrell) and my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), which were full of wisdom and clarity about the way ahead. I wholly agree with the picture painted by my right hon. and learned Friend the Member for Rushcliffe, who took a tremendously national view of the NHS, to which I wholly and unreservedly subscribe.
	In 23 years as an MP, I have never known such anger and anxiety directed at the Government as is now being generated on national health issues. Since I became the Member for Mid-Sussex in 1997, there have been four reviews of hospital servicesnothing like as many as experienced by my right hon. Friend the Member for East Hampshire (Mr. Mates)in my constituency and local area. We have had Modern Hospital Services for Central SussexA challenge for us all in 2000, and even more ridiculous names such as Strengthening Hospital Services in Central Sussex in 2001 and the Best Care, Best Place consultation in 2004. Now, 18 months on, we have a new document that sweeps all the rest into the waste paper basket: Creating an NHS Fit for the Future.
	Those reports were all subsequent to a document commissioned by the West Sussex health authority, which was faced in 2000 with growing fragmentation in health care provision, escalating and disproportionate management costs and rapidly accumulating debts, which are at the nub of our present unhappy state. Matters were so serious that the Government asked Michael Taylor, then chief executive of Oxfordshire health authority, to investigate and report on West Sussex as a failing and debt-ridden health authority. His report, which was damning, set out a series of recommendations, which were by and large completely ignored by Candy Morris, who was acting chief executive of West Sussex health authority until its demise. She was also responsible for the NHS consultation documents from 2000. By an astonishing quirk of fate, she is now one of the architects of proposals about to be announced for the apparent deconstruction of the NHS in West Sussex.
	Those changes will throw the NHS in Sussex into even greater turmoil than is already the case. What Taylor exposed was a series of top-heavy management structures, in expensive premisesthe sort of point made by my right hon. Friend the Member for East Hampshireinvolving duplication, replication and wastefulness. No one paid any attention to his warnings and this continuing, wilful mismanagement of the NHS has now led to colossal debts of well over 100 million in West Sussex.
	Another important contributory factor in this debacle has been the complete failure of the independent watchdog bodiesfirst, the community health councils and latterly the West Sussex health scrutiny committee and joint scrutiny committeeto refer any of the proposed configurations to the Secretary of State for intervention and for her to account to Parliament directly on that managerial vandalism.
	What the Secretary of State must understand is that when the Best Care, Best Place consultation began in November 2004incidentally, it was a total sham, in which, again, the scrutiny committee failed to actit was represented to all my constituents and me by the management of the strategic health authority, and most especially by the primary care trust, as the way ahead for the foreseeable future. Many of them were deeply cynical of the Government's motive at the time, but they went along with it.
	As recently as 25 May, at a meeting that I called in Burgess Hill in my constituency, the chief executive of the South East Coast strategic health authoritya newly created animalnever mentioned any of the changes that were likely to happen, even though they were being discussed at board level and elsewhere. My constituents and I feel that that amounts to a deceit, a betrayal and totally unacceptable behaviour by the management of the NHS, which has lost its way and has been party to the waste of hundreds of millions of pounds over recent yearsmoney that could quite well have been spent on patient care.
	I have referred that catalogue of incompetence and bad practice to the Comptroller and Auditor General, who, alas, cannot take it any further, but he has referred me to his excellent report on financial failings in the NHS. What I hope that the Secretary of State will understand is that we in Sussex think that her Department seems rather like the American Administration: apparently, at the same time, dysfunctional and fragile and unable to admit or unwilling ever to seelet alone to correctthe obvious mistakes that are being made in their name.
	The constant reorganisations of the past few years may create for the Government an illusion of progress and reform, but in practice what has often happened in the recent past is that it has produced confusion, uncertainty, gross inefficiency, very serious staff demoralisation in excellent hospitals and, above all, a lack of a coherent sense of direction by managers.
	Our area is expected to accommodate 41,000 new houses in the next 20 years; our local infrastructure is woeful. I have drawn to the House's attention on many occasions the infrastructure deficit in my constituency, yet with all the added pressure for existing and future growth it is clear that the PCT plans to downgrade the Princess Royal hospital by removing the accident and emergency department altogether, although I was assured by a Minister at the Department of Health on the Floor of the House a year ago that there was no question of that happening. Indeed, the Best Care, Best Place consultation document said that both the Royal Sussex County and the Princess Royal hospitals will keep their A and E departments. Those assurances turn out not to be worth the paper that they were written on.
	Brighton, where the A and E department is to be removed in totality, is hopelessly inaccessible by road. Its hospitals simply cannot cope with the load that is being placed on them, with patients constantly being referred back to the Princess Royal hospital. Gatwick airport is only 15 miles away, and there is always the possibility of a major catastrophe. In times of conflict, the Princess Royal hospital would be needed as a casualty clearing station. There is a major and very busy motorway on the doorstep, combined with very high housing and population growth.
	This weekend, I hope that thousands of people will march in Haywards Heath in an all-party campaign to support the Princess Royal, to draw the attention of Ministers to the fact that we cannot allow our services to be downgraded, because that is not safe, and to complain about the instability of the service provided to local people. Although I agree with my right hon. and learned Friend the Member for Rushcliffe that there have been many changes for the better and that excellent changes are afoot to move services into the local community, interfering with the fundamental infrastructure of the health service in the way that is being done is a fatal mistake.

Bob Blizzard: One of our greatest human failings is our lack of memory. I fear that today and in the weeks ahead the Conservatives will try to play on that by hoping that people will forget what the national health service was like in 1997. I would like to remind the House of what it was like in my area. Like everywhere else, we had long waits for elective treatment18 months was the norm and, as we have heard, it could have been anything up to two years. The biggest change in the health service over the past 10 years is shown by the fact that nobody in my constituency now waits more than six months.
	Going to accident and emergency in 1997 was really unpleasant. One could expect a long wait in crowded conditions in an environment that was miserable rather than comfortable. The second biggest change that we have seen is that today one can go to a completely modernised accident and emergency unit that is not crowded and one can be treated in under four hours. My hospital achieves that for 98 per cent. of patients.
	They were chaotic times back then. The first national trust to go out of business was in my area. The Anglian Harbours NHS Trust, a community services trust, did not just have a deficit, but crashed and went out of business. Local NHS managers had to pick up the mess. Lowestoft community hospital was threatened with closure and, yes, we marched up and down the streets to save it, and we managed to under this Labour Government.
	Mental health care was a complete failure in my area, with appalling Victorian and inconvenient in-patient facilities. Community mental health services were thin on the ground so that when I and my hon. Friend the Member for Great Yarmouth (Mr. Wright) were elected, we decided to march off to the Secretary of State to get something done. Thankfully, the regional health authority accepted our case and put matters right.

Graham Stuart: Will the hon. Gentleman turn his mind to looking ahead? As my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) said, if we looked back, we would see significant improvements in any 10-year period such as the 81 new hospitals that were built under the last Conservative Government. Will the hon. Gentleman follow the example of the hon. Member for Pendle (Mr. Prentice) who looked at the difficulties, which does not mean denying that improvements and benefits can be found? Looking at the problems and concerns today about the failure of productivity would help us to get a better deal for patients. After the hon. Member for Dudley, North (Mr. Austin), we have yet another party political rant based on the memories of what happened 10 years ago, and that is an entire waste of time. The hon. Member for Waveney (Mr. Blizzard) should focus on tomorrow and the issues that we face today and try to make a difference not just to his party.

Bob Blizzard: If we want to understand the future, we have to understand the past.
	We thought of going to the then Secretary of State, my right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson), because he had already intervened in the East Anglian Ambulance NHS Trust, which habitually failed to achieve its target response times. That trust delivered last year the fastest response times in the history of East Anglia.
	All the trusts at that time found difficulty recruiting staff because pay was low and the NHS was just not attractive. That was the dismal picture of the Tory NHS that we endured for 18 years. We had reorganisations too and I will declare an interest: my wife works for the health service and she was reorganised and reorganised again. Sadly, she has been reorganised a few more times since this Government came to power, but one of the worst things the previous Government did was split the Great Yarmouth and Waveney district health authority and the natural health economy that shares the same hospital. I am delighted that the Secretary of State put that back together again in the recent PCT reconfiguration.
	The transformation today is so great that if I had promised what we have today in 1997, I probably would not have been believed. The cornerstone of our local health service is our general hospital, the James Paget. So much investment has taken place in the hospital that I have no time to list it all. We have had our share of the extra doctors and nurses, a new accident and emergency unit, as I have said, new theatres, intensive care units, maternity units, pathology facilities, eye units, new renal stations, scanners, digital X-ray, and most recently a new emergency admissions and discharge unit, which is helping to make the hospital far more efficient and to treat more people.

Simon Burns: I am interested to hear the hon. Gentleman outlining all the investment in his hospital, but would he tell the House of his concerns at the east of England strategic health authority review, which has just begun, and comment on rumours that his hospital might face closure or cuts?

Bob Blizzard: If the rumours are being spread by Conservative Members, they will be very disappointed

Simon Burns: Will the hon. Gentleman give way?

Bob Blizzard: No; I have given way twice. I am absolutely confident that our hospital will remain a first-class district general, and I will not accept scare stories spread in this House.
	The hospital is high quality because it has met every target set for it ahead of time: 100 per cent. of people do not wait six months or more; 100 per cent. of cancer patients are seen in two weeks; 100 per cent. of those diagnosed with cancer are treated in one month; and 98 per cent. of people who turn up at A and E are seen in under four hours. My local hospital has got to grips with MRSA: last year it saw 300,000 patients and had 41 cases. It has had only 14 cases in the past seven months, but it wants to do better. Even its food was given a 98 per cent. satisfaction rate among patients in a recent national survey. That is why the hospital has been a three-star trust for successive years, why it has had no deficit for 2005-06in fact it had a surplusand why in August this year it became a foundation trust hospital, joining the other 47 in the country.
	I have been calling it the James Paget hospital, but its new name is the James Paget University hospital, because it is now part of the new medical school that was established at the university of East Anglia, which has done so much for the health service in our area, bringing new, young medics whom we can recruit when they qualify.
	This year will be a challenge for the hospital, but it is having to make no redundancies and I am increasingly hopeful that all the trainee nurses will get jobs. In another recent national survey, on staff satisfaction, the hospital came 10th among 200 surveyed.
	That is a great performance and it has been aided by innovation. I told the House last year about the work of orthopaedic surgeon Mr. John Petri, who carries out dual operating and so has no waiting list. He moves between two theatres and two teams. If hon. Members want to do something for their local health service today, they should ask their hospitals why their orthopaedic surgeons are not carrying out dual operating and getting waiting lists down.
	The future is bright for my local district hospital. As a foundation trust and a self-governing hospital, it has 40 million to invest over the next five years on ward upgrades, to enable it to exercise even better infection control, and on upgrades of patient facilities too. Its aim is to be a full district general hospital of high quality. That is what local people want and I am confident that that is what it will remain.

Tim Farron: Will the hon. Gentleman way?

Bob Blizzard: No. I have taken two interventions and I get no more extra time.
	The purpose of my telling the House about the hospital is that the James Paget hospital shows that a well run NHS hospital can operate within the finances available to it, meet all its targets and deliver quality services without any deficits.
	I do not have time to go into so much detail on primary care and community services, but suffice it to say that Waveney primary care trust set out its own care closer to home approach before the Government paper, so we see an important role for our community hospitals. The Lowestoft hospital, which faced closure, has had a major overhaul with massive investment, and I welcome the Government's announcement of 700 million more across the country and hope that some of it will come our way.
	Many of my constituents in the western part of the area are served by All Hallows hospital. It belongs to a charitable trust and has provided services for many years for elderly NHS patients in my constituency and in south Norfolk. A problem arises, however, when two neighbouring trusts do not move in the same direction, and we have such a problem at the moment with South Norfolk PCT, which is talking about reducing the number of contracts. If it does that, there will be a knock-on effect in my constituency, where the local trust wants to go in another direction, so I hope that we will see greater co-ordination. With practice-based commissioning, I know that local people will want to choose that hospital and that GPs will want to send them there, so with that type of commissioning and the new payments system, we hope we have a future.
	As I said, the best thing to happen to primary care in my constituency was the formation again in the recent reconfiguration of a Great Yarmouth and Waveney PCT. That organisation can focus on commissioning the health services that are right for our local area based on local need, working closely with local GPs to serve local people, maintaining that relationship with the local hospital, and getting the funding appropriate to our needs. In mental health, we have brand-new facilities for in-patients. The ambulance service has turned itself around completely, as I said, and I expect it to get a good rating from the Healthcare Commission tomorrow.
	What has made the difference since 1997? Obviously, the increased funding, which the Conservatives opposed, has made a great deal of difference, but the other element that has made a difference is targets. The Opposition criticise targets, but if life was so good without targets, why was the NHS such a mess in 1997? I admire medical professionals; I work closely with them and I know that they are dedicated, but they need co-ordination and direction. I do not think that we can simply leave them alone to get on with it.
	That raises the question: what is the role of politicians in the NHS? I attended a meeting in Manchester where a gentleman from the British Medical Association kept referring to politicians meddling in the NHS. Well, my constituents expect me to meddle in the NHSthey elected me to meddle in the NHS. Every month some of them write to me asking me to meddle in the NHS, and the people who ask me to meddle the most are BMA memberslocal doctors. They ask me to lobby Ministers to get things done, and sometimesquite regularly, in factit works. If politicians do not involve themselves in that way, people will ask what is the point of voting for them and turnout will fall even lower.
	I do not want to hand over the NHS to an independent board. I do not believe that it would be independent or be seen to be independent. Politicians would still get the blame for things that go wrong, but they would have no power to deal with them. I wonder what an independent board would become under the Conservatives. I worry that it would float away in the direction of charges, self-pay, patients' passports, vouchers and all the other principles that we have often heard stated by Conservative Members.
	I think that the NHS is safest in politicians' hands because the British people, who cherish the NHS, will punish those politicians who do not look after it, as they did the Conservatives in 1997. Politicians know that. That is why we are committed to the NHS and why the Conservatives just pretend to be. The Conservatives and their newspapers are trying to present a picture of an NHS that is falling apart, but the NHS Confederation has just published a report, Lost in translation, which points out that when people who have been in hospital are asked about the experience, they say that they had good treatment. Some of them think they were lucky, but they were not lucky; they just voted Labour three times and they now have a Labour NHS.

John Pugh: I shall be brief, because much of my thunder has been stolen by the hon. Member for Pendle (Mr. Prentice). I could not better his critique of what is going wrong in the health service.
	The main focus of the debate is on NHS planning, or the lack of it. NHS planning is in danger of becoming an oxymoron, like journalistic balance. Although it is not my habit, I can best illustrate that point using events in my constituency, where we have the usual litany of modern NHS ills, especially in the acute sector. Only this week, we had another ward closure; this summer, we had ward closures, cutbacks and redundancies, not only among support staff, but on the clinical side. All year there has been anxiety about deficits and disputes about their cause and the solution to them. We have seen plenty of management consultants, plenty of hassle and plenty of controversy. Despite all that controversy and hassle, the staff have got on and delivered an exemplary service, but the word planning has no place in their world that they can understand. One can plan only when one properly understands the environment in which one is working, and there is no evidence over the past 10 years in my constituency that anybody has been able to do that.
	Ten years ago my local trust, which controls two hospitals, tried to deliver a plannot a very good plan, but it was based on allegedly clinical criteria. It was based on the demands of the medical profession for safety, clinical standards, training capacity and so on. It was deeply flawed. It had children who had suffered any kind of trauma or accident by-passing a fully fledged casualty department, and it was not acceptable to the people of my constituency. It was supposedly and unconvincingly based on the latest recommendations from the royal colleges, but it was at least coupled with a substantial new build investment programme.
	However, even before the quoted medical advice had changed and before the plans were allowed to settle down, they were all thrown into the melting pot by the unexpected implications of junior doctors' hours and changed conditions and the European working time directive, none of which hospital managers could do a great deal about. Just as that was heading for a settled outcome, payment by results appeared on the radar, ushering in uncertainty and further turmoil. Management consultants then proposed clinically absurd proposals at variance with all the previous proposals, and the new capital investment under payment by results became a financial millstone. The accountantsMcKinsey's, Ernst and Young and the restrather than the doctors appeared to be calling the shots.
	That was not planning. It was reactive. It was crisis management. It is crisis management, but each crisis is internally generated. The public are left baffled and angry and the politics is messy and at times unpleasant. At the height of all this, there was a blessed moment of sanity in my constituency. The primary care trust, backed by the strategic health authority, took matters in hand, called all the parties together, sat them down and asked simply, What do people here need? What can people fairly expect to receive? Genuine consultation took place and for a time real solutions seemed to be in the offing. It was a model of crisis resolution.
	Clinical networks were planned, sensible co-operation between all parts of the local NHS was envisaged, including specialist hospitals such as Alder Hey, and a genuinely workable road map was worked out, but then it all got parked. The PCT was abolished, the strategic health authority was abolished, the plans were sidelined, clinical networks were dropped and people were moved on. New financial goals were set overnight, management consultants from outside came in again, politics intruded again and the local NHS was turned upside down again. Financial considerations seemed to dominate over clinical delivery.
	Like most trusts in the NHS Confederation, my trust is reciting the current mantra that so many beds and so many nursing staff may not be necessary. People cite figures showing the considerable fall in hospital occupancy over the past decade. However, they omit to tell us that the number of acute beds, as opposed to beds for maternity and the elderly infirm, has not fallen appreciably. We get flimsy clinical excuses for financially based decisions. Looking on anxiously in almost every constituency are the poor publicthe citizen, whether ill or wellunable to detect the shape of future services, unsure of what awaits them, and unconvinced of the existence of even a Baldrick-like cunning plan.
	As I look back over the past decade, I can detect periods when the concerns of doctors were dominant, periods when the interests of hospital administrators were dominant, and times such as the present when the voice of the accountant and the management consultant is dominant, but I have yet to experience a period in which the voice of the community and the patient is dominant, and I have yet to see an argument against it.

Patrick Hall: When I was first elected to represent Bedford and Kempston in 1997, a regular feature of my postbag then and for some years thereafter was people asking for help because of the consequences of excessive hospital waitingthe pain, the living in distress and the time off work. Many people were driven to the private sector. If that goes too far, it undermines the principles of the NHS. That is the way it was nine years ago. Today, I hardly ever have such a case brought to me by a constituent. People acknowledge that there has been a real improvement in waiting times. The Conservative party must hope for a national collective outbreak of amnesia on this point if it is to make progress with its claim to be the true party of the NHS.
	The Government have even more ambitions than their achievement so far. The plan is that, by the end of 2008, the overall maximum wait in the NHS will be 18 weeks. That is from GP to operation, including diagnostics, and that has never been attempted before. In practice, for many interventions, that will mean an in-patient treatment wait of seven or eight weeks, which will truly revolutionise the NHS.

Kitty Ussher: Does my hon. Friend agree that, under this Government, not only will the waiting time become a maximum of a mere 18 weeks, but that in the Conservative years it was 18 months?

Patrick Hall: It was 18 months and sometimes more, with no prospect of improvement; quite the contrary.
	The other aspect of modernisation and improvement of the health service is the switch to primary and community careaccessing health care more at local GP surgeries, local clinics and enhanced pharmacies, and treating people in the home if possible.

Tim Farron: I acknowledge the investment in the NHS and the move towards community services, but the problem is that acute services cannot be operated directly in the community; they need decent sized hospitals that are relatively close to where people live. One consequence of concentrating on specialist hospitals alone is that, in rural areas such as mine, one ends up with the situation such as that at Westmorland general hospital where the medical emergency admissions may soon be shut down because of the drive for the best. The best is becoming the enemy of the good enough. Does the hon. Gentleman accept that we need to ensure that we have safe services that are close enough to people for them to get there in time to survive and be stabilised when they have conditions such as heart attacks?

Patrick Hall: I did not follow that entirely, but yes, of course, we want a better NHS, if that is what the hon. Gentleman said. If we have more services in the community, that will free up the acute sector to enable it to treat more people more quickly. If people have to go to hospital, they want the prospect of safe treatment without having to wait too long and as locally as possible, although that depends on the nature of the operation that they face.
	Not enough has been said about the plans to modernise the NHS. It has not been sufficiently reported. It involves change and change can be difficult, but it is a good news story which, when I discuss it with NHS staff and constituents, is one that they can broadly sign up to, even if it goes under the peculiar term of reconfiguration.
	But the context has dramatically changed in recent months, and that context arises from the consequences in Bedford of the Bedford Hospital NHS Trust's 11.8 million deficit. I do not have time to go into why there is that deficit, but it is combined with the Government's decision this year to address the NHS's overall deficit of the last financial year by top-slicing the budgets to PCTs, and the two together have created real pressures. They are short-term financial pressures, but they could lead to up to 200 redundancies at Bedford hospital, although the figure is likely to be significantly less. Nevertheless, it is worrying, and damaging to staff morale, and it will slow up the development of the consequential primary care services that will be needed if there is to be a shift to some extent from acute to primary. Such uncertainty is bad for staff morale and the public do not understand what is happening. They know that there have been improvements and that there is a lot more money year in, year out, but they face difficulties such as they have not experienced for years. That situation provides fertile ground for others to increase people's fears by telling scare stories. In the case of Bedford hospital, the scare stories were started by the Liberal Democrats in  The Daily Telegraph on 14 September. The scare tactic involved saying that Bedford hospital is scheduled for closurea Bedford hospital consultant went on the record to make that point and Bedford and Kempston Conservative party is circulating a leaflet reinforcing the fear of the threat of closure. Let me make my position clear. I totally support Bedford district general hospital as a viable district general hospital. The hospital is not at risk from closure, and it is wholly wrong to whip up fears that it is.
	The important issues are more difficult. The serious issues facing Bedford district general hospital are managing the four-year financial recovery plan to eliminate the hospital's debt, changing the shape of local NHS services to improve them for the long term and ensuring that those two tasks are carried out while maintaining a full range of services, particularly the 24-hour accident and emergency service. Those are the challenges in Bedford, and they clearly worry my constituents. We are not helped by fears being whipped up unnecessarily, which goes on day in, day out in my constituency.
	There are real problems that we must face up to, so what should we do? First, when changes are prepared and published, there should be a three-month statutory consultation process with which people are urged by all parties to engage on the basis of facts and a measured and informed debate rather than on the basis of scare tactics.
	Secondly, the Government must examine RAB, the resource accounting and budgeting financial management system that now applies across central Government. The principles of RAB have supposedly been applied to NHS trusts across the country, which means that, if a trust reports a deficit in one year, its income is reduced by that amount in the following year. That is a double whammy, which is unfair and guaranteed to make a difficult situation worse. Furthermore, the in-year deficit is reported to the balance sheet reserve and carried forward cumulatively. Bedford hospital trust reported an income and expenditure deficit of 8.48 million in 2004-05, and Bedford PCT passed on a reduction in its service level agreement income of that amount in the following year as a result of RAB. However, because that reduction would have devastated the hospital, which would not have been able to pay many of its staff, the trust was permitted to borrow that sum from the strategic health authority. That cash borrowing, which did not appear in the accounts in the normal way, was interest-free, and the sum was to be paid back in the following year. In 2005-06, the in-year deficit was reduced by the trust to 3.41 million, which under RAB should have led to a cut in its income of that same amount in this financial year, but that did not happen, because a deal was done with the SHA.
	I hope that Ministers look carefully at the Audit Commission's review of the NHS financial management and accounting regime, which contains a clear and powerful critique of RAB and the labyrinthine system of complex financial devices which dominates, and has always dominated, the NHS. It calls for an end to RAB being applied to the NHS and for a system of much greater clarity and transparency. What is happening to Bedford hospital reinforces the message from the Audit Commission. In one year, RAB was applied, but cash borrowing was allowed to cover the cut, and then it was not applied in the next year.
	Some might say that we muddled through and that the situation is okay, but I disagree, because the system is bizarre and confusing, and it perpetuates a culture within the NHS that is not businesslike. If RAB were not applied to the NHS, as proposed by the Audit Commission, which has also made suggestions for improvements, Bedford hospital and other trusts with deficits would still have to address their deficits. We are not talking about just wiping deficits clean and pretending that they do not exist, but at least we could then build on a system that enables clear planning, openness and transparency which more people than just the finance director could understand. The NHS needs that important development, so that it is not just left to the finance director to understand the finances, and so that all elements of a hospital, for example, contribute to financial efficiency.
	It is also important to get rid of RAB so that we abolish its cumulative balance sheet feature. That element might not appear to matter, but it will from April next year when the capital funding regime is due to change and an NHS trust's ability to borrow will partly be judged by the state of the balance sheet. Under RAB, while Bedford Hospital NHS Trust should eliminate its deficit within four years, the balance sheet will show the deficit for eight years. That is a wholly ridiculous situation.
	Thirdly, we should continue to close the gap between what the health economy in Bedfordshire gets and what it should get in terms of its capitationthe system known as fair funding. Year on year, in Bedfordshire, despite Conservative claims that somehow money is being robbed from Bedfordshire in order to over-fund the north of England, this Labour Government are closing the gap with regard to fair funding. We need, however, to continue that process.
	Fourthly, we need a period of stability within the NHS

Graham Stuart: Come and join us.

Patrick Hall: I am not going to not say something just because some Conservatives may agree with me. Sometimes, it is important to unite on issues in the national interest. I am speaking up for my health economy and my hospital, and I do not mind at all if Conservatives wish to support me in that. We need stability, because there has been too much structural change. Some welcome reforms, such as practice-based commissioning, the choose-and-book system and payment by results, are about to be introduced, but it is all happening at once. Whatever we do in reform and in government, there are still only 24 hours in the day, and sometimes things get a little too much.
	The Government have a good strategic policy for the national health service, which is one of the reasons that Labour got elected in 1997 and has been re-elected twice. We have an exciting vision for the national health service that does not just end now but continues for the decades ahead. At the moment, however, it is to be delivered by a wholly inadequate financial management system, which is undermining delivery and urgently needs reform. I urge my right hon. and hon. Friends on the Front Bench to take on that point with seriousness.

Simon Burns: I listened carefully to the speech by the Secretary of State for Health. The sheer horror of the situation suddenly came to me when I realised that either she is living in cloud cuckoo land or she is in a total state of denial about what is going on in the real world beyond this Chamber. Like all Members, the Secretary of State has constituents and, I presume, receives correspondence every day from them and the wider public because of her public role. I am amazed that she seems to think that everything is going well in the NHS and that there are no problems.
	Equally, it is fatuous for hon. Members, Ministers and others simply to refuse to accept that the previous Government did good things in the health service. Since 1997, this Government have also done good things for the health service. As my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) rightly said, there is a growing consensus in this Chamber and the country over the national health servicea consensus to which I have adhered from the first day I entered this Housethat we should have a first-class health service, based on free access for those eligible to use it and paid for by taxes, except for those areas on the fringes that, historically, have not been free at the point of use, such as prescription charges.
	If we work from that basis, we have a golden opportunityespecially given the revenue that the Treasury has been able to glean in the past 10 years because of the economic situation that resulted from the difficult task on which my right hon. and learned Friend embarked on in the mid-1990s and the record amounts of money that the Government have put in, which it would be foolish not to acknowledgeto introduce fundamental reforms to ensure that we get value for money from our investment and that patient care improves. There have been improvements in the health service in the past 10 years, but there are also some significant problems. Because of the lack of structural reforms to improve productivity, we have returned to short-term thinking to try to address the emerging problems.
	My constituency has a fantastic local hospital in Broomfield hospital, which has an excellent management team and a first-class, hard-working and dedicated staff. I pay tribute to them, but there are problems because the money that has been made available in record amounts by the Government is not reaching front-line services at the level and in the scope that we would expect. Chelmsford PCT has a deficit of 13 million. To try to overcome that problem, as it has been told to do, two intermediate care wards have been closed completely, so there is now a gap in intermediate care that will have a knock-on effect on the local hospital and, potentially, delayed discharges will begin to escalate again.
	We also have a problem with the hospital trust. Some 200 jobs will be lost or not replaced to meet its financial deficit. We also have a nurse training school at the Anglia Ruskin university. Four or five years ago, the Department of Health was trawling the third world for nurses to work in our health service because it was short of nurses. More and more people were encouraged to train as nurses and investment was made in their training, but now that they have those nursing skills there are very few jobs for them. That is a terrible waste of investment, their talents and their potential contribution to improving and enhancing the national health service.
	I wish to raise another issue that illustrates the problems of the NHS. Before the last general election, the Mid Essex Hospital Services NHS Trust came up with a brilliant PFI scheme worth 180 million. Chelmsford has two hospitalsBroomfield hospital, which is an old tuberculosis hospital that has been modernised and is now state of the art, and St. John's hospital, which was built in Victorian times and is way past its sell-by date. Contrary to what the Secretary of State saidit did not fit her agendathere are Conservative Members who support hospital closures when they see the logic behind them. From the outset, I have supported the closure of St. John's hospital, as have the medical staff and my constituents, because the services were to be moved four miles to the Broomfield hospital site. That is the right thing to do when the building is outdated.
	The PFI scheme was put together and I fully supported it. It was the centrepiece of the West Chelmsford Labour party's election campaign in 2005the Government's investment in the health service. I have to hand it to them, because it is a centrepiece that would deliver an improvement in health care. The scheme was ready, it had been validated and approved by the Essex strategic health authority, and it went to the Department of Health in October for final approval. Unfortunately, the Department could not get its act together and, having said that we would have a decision by the end of November and then by the end of the year, it had still failed to make a decision by late January. At that point, the Chancellor stepped in and said that all PFI schemes had to be revalidated, so we were back to square one.
	I raised the issue with the Prime Minister in May. I gave him advance warning and, to be fair, he gave an excellent answer, including the hope that
	it will have an optimistic conclusion.
	He said that he would look into it and that he could give me
	an assurance that it will go ahead as quickly as possible, once the remaining issues have been sorted out.[ Official Report, 10 May 2006; Vol. 446, c. 310.]
	I was grateful to the Prime Minister for that response, but it is now 11 October, and the plan has not received the go-ahead. It has also been scaled down, to a probable value of 80 million. If it finally receives approval, the hospital will have 200 fewer beds than it has now, and the outcome will not be the tremendous, state-of-the-art improvement originally envisaged.
	I wrote to the Minister a month ago, and he kindly replied to me today. The trouble is, his letter says nothing in response to my real questions. If the plan fails and does not get approved, the Prime Minister will look foolish. If that happens, I will feel a bit sorry for the people who briefed him when he gave me the assurances and commitments in May. However, there will also be the knock-on effect that a significant amount of money will have to be repaid if the project falls apart and is abandoned. That money could have been invested in health care and front-line services and used to wipe out the deficits of the Chelmsford PCT and the Mid-Essex hospital trust. I think that the East of England SHA is the cause of the problem. Going to see the people there would be a waste of time, as they would tell me nothing new. The Minister must look into the matter and try and get everyone working together, as quickly as possible.
	In conclusion, it would be stupid to suggest that everything is wrong with the NHS at present. It would be equally stupid, however, to suggest that everything before 1997 was appalling. One should give credit where it is due, but Ministers and the Secretary of State must stop patronising the House. The right hon. Lady speaks to hon. Members like a know-all head teacher speaking to naughty schoolchildren. She must accept that there are significant problems with health care delivery in parts of the country, and in certain areas of medicine.
	Those problems have to be addressed. I applaud the record amounts of money that the Government have made available, but that money must be channelled towards front-line service and the provision of even better health care. It must not be wasted on bureaucracy and ceaseless reform. We need stability, so that the NHS can get on with providing the finest possible care for all our constituents.

Andrew Gwynne: I welcome this debate, and am very pleased to be able to contribute to it. I should like to speak about the demands that the NHS faces, and to which it must respond. Demand for a mass health system is not always visible. I have many constituents in parts of Denton and Reddish who need NHS support but who do not actively seek it.
	I think that that is the challenge. Of course, the NHS must respond to the demands made on it, but it must also find new ways for those demands to be made, and especially by the most dislocated and vulnerable people in Britain. The debate has moved on from being simply about quantities of investment. Stephen Watkins, the director of public health in Stockport, has written:
	For several years now the Government has been investing very large sums of new money into the NHS. This money far exceeds anything that would have been dreamed of throughout the late 1970s, 1980s, or early 1990s. Those who called for UK health spending to be increased to the European average were dismissed as unrealistic dreamers. In 1996, the BMA said that 6 billion of real new investment was required for the NHS and was attacked by other health organisations for going over the top. In 1999, the Government injected 12 billion of real new recurrent money to start a process of increasing NHS spending to the European average.
	He continued:
	With this additional money the NHS has dramatically improved.
	That is not a political statement. That comes directly from the director of public health in Stockport and his 2006 public health annual report. Clearly, the level of Government spending was the argument in the 1990s. To solve the problems that the NHS may face in the future requires reform for our changing society.
	The Labour Government who took office in 1945 were a response to the demands of post-war Britain. War and sacrifice, both at home and abroad, led to the most demanding British electorate since the emergence of mass suffrage. That electorate demanded that the Government provide a free and first class health service for all throughout the country, and the Labour Government responded. The British people have, of course, changed a great deal since the 1940s. They have become ever-more demandingmy constituents included. Their expectations are much higher and rightly so.
	As we look to the future, this will become an increasingly ageing society. The number of people aged 85 and over has grown to a record 1.2 million. That is resulting in ever-increasing demands on the NHS, but also in many more hidden and vulnerable peoplesometimes without family supportwith whom the NHS must make meaningful contact. As in the past, the national health service must be reformed and expanded to cope with the changes. By 2025, the number of people aged over 85 will have increased by two thirds. Each of those people will need, on average, five times as much care as the average 16 to 44-year-old. An NHS that can cope with those pressures requires both investment and reform. In fact, the NHS's ability to be reformed and to meet the challenges of the day is why it remains one of the most popular institutions in Britain.
	During the 1980s and the early 1990s, NHS staff were let down by the Government. During the 1980s, the Conservatives managed to build just one new NHS hospital in Britain. Since Labour came to power in 1997, we have turned that decline around. By 2008, more than 90 billion will be invested in the NHS, in a huge range of services. As a result, the NHS is treating more people and treating them faster than ever before, with treatment free at the point of need and available to all.

Grant Shapps: Will the hon. Gentleman give way?

Andrew Gwynne: No, I will not.
	Stepping Hill hospital is being rebuilt and Tameside general hospital has been approved for a massive 80 million private finance initiative investment programme. That will include the building of a new state-of-the-art health facility, including an expanded and improved accident and emergency department. The improvements being made to the NHS are, however, not simply a result of investment, but of careful reform. The Conservative party did not want careful reform. Just over a year ago, the Tories believed that the best way to help the people of Britain would be allow the wealthy to pocket NHS money, provided by hard-working families all over Britain, and take it away to subsidise private treatment. That would have left areas in which people have relatively poor health and low incomes, such as parts of my constituency, starved of much-needed funds. The Tories are still at it. Having voted against the extra investment in the NHS, they now want that money to be spent only in their areas, where deficits have accrued. They cannot campaign for more money in public while voting against it in the House of Commons.
	Our challenge is to find the most efficient way of providing health care to all, not the fastest way to drain the NHS of funds. If NHS money is better spent caring for people in their own homes than in hospital beds in large general hospitals, that is what should be done. If the money is better spent on specialist units, that is what should be done, and if the money is better spent on an expanded and improved accident and emergency department at Tameside general hospital, that is what should be doneand that is what is being done.
	A modern NHS requires a range of different services to provide the best care. If money is taken away from one service, it is not being cut or disappearing. It is being channelled towards a service that is better for more patients. The NHS survives through reform and investment. British society has changed immeasurably. We are living longer, becoming more demanding and expect state-of-the-art treatments when it is convenient for us, and rightly so. The people have not, however, changed their minds about the NHS. My constituents want the NHS. They want the first class state-of-the-art treatments that will soon be provided by the new 80 million investment at Tameside and by the new facilities at Stepping Hill, but they also want the freedom to choose when they want that treatment and whether they would rather stay in hospital or recover, supported by medical practitioners, in their own home. Many of my constituents are not the wealthiest people in Britainfar from itbut they deserve the best possible treatment.
	The history of my Greater Manchester constituency is one of change. Denton was famous for making hats. Huge swathes of the population of Denton and Stockport were involved in hat manufacturing, as well as other textile and heavy industries. Today, the people of Denton and Reddish lead different lives, so the NHS must continue to find new ways to make itself accessible to people with varied lifestyles. It has been argued by many that the importance of choice in health care is exaggerated. No; choice in health care is not like choice in shoppingit is much more important than that.
	Many people in my constituencyoften those in the most deprived areasare not sufficiently connected with doctors and nurses. Those connections must be strengthened for the sake of both my constituents' health and the efficiency of health provision. If my constituents, some of whom are trying to hold down two or three part-time jobs, cannot choose when and where they and their families access health care, their quality of health and NHS money will be wasted. If a range of times and locations are not available to those in need of treatment and advice, appointments will be missed. When that happens, treatments and advice are not given, medical practitioners are not able to understand further their patients' needs and public money is wasted. Without more freedom, many of my most vulnerable constituents will not access health care and health advice.
	The health profile of England maps, which were published yesterday, show the problems that we still face, and I am well aware that my constituents face them every day. Like many northern areas of England, Denton and Reddish has higher obesity rates, more smoking-related deaths and, consequently, lower life expectancies than the English average. Men can expect to live for 74 years and women 79 years, but both figures are lower than the national and regional averages. The goal for the NHS should be to make it as easy as possible for those in need to receive the advice and treatment that they need to the end the health divide.
	Under the Tories, the funding for hospitals was skewed towards richer areas, which embedded inequalities. The Labour Government are reforming the system because we believe that the divide is unacceptable. Since my election, I have worked hard in my constituency to ensure that our local PCT and acute services are reforming their provision of care. The Labour record on expanding NHS capacity should not be in doubt. Labour health reforms have been, and will continue to be, changes for the better.

Tony Baldry: Various things have happened in the NHS in the past year. The crisis involving deficits affected many NHS trusts and demonstrated itself through the closure of many community hospitals, or, in my constituency, the non-opening of a new community hospital, which the right hon. Member for Darlington (Mr. Milburn) had promised from the Dispatch Box when he was a Health Minister. He said that we would have a new and enlarged community hospital in Bicester, but that has not happened and clearly will not now happen. The Secretary of State's speech gave us no explanation of why the Government have suddenly turned their back on community hospitals.
	We are now moving towards another trend of downgrading so many services in smaller general hospitals that they effectively cease to be general hospitals. Such a thing is proposed and threatened for the Horton general hospital in Banbury. The hospital serves a large catchment areamuch of south Northamptonshire, much of south Warwickshire and west Oxfordshirewhich is why today my right hon. Friend the Member for Witney (Mr. Cameron), my hon. Friends the Members for Stratford-on-Avon (Mr. Maples) and for Daventry (Mr. Boswell) and I have submitted a joint observation to the Oxford Radcliffe Hospitals NHS Trust. If hon. Members want to read it in full, it can be found at www.save-our-services.com. The important point is that we say:
	We believe that the Oxford Radcliffe NHS Trust, the Strategic Health Authority and the Government should be seeking to ensure that we can keep the Horton as a General Hospital delivering all the clinical and medical services that one would reasonably expect a local General Hospital to deliver,
	which seems not unreasonable.
	The tragedy about the proposals is that they are not a consequence of the trust saving particularly large sums of money. In fact, over a full year, the trust would save only some 1 million to 1.3 million, which is between 0.25 to 0.5 per cent. of the total Oxford Radcliffe Hospitals NHS Trust budget. If the trust, the strategic health authority and the Government had the will, they could find those savings elsewhere in the trust budget without leading to a significant downgrading of services at Horton general hospitala downgrading that will have a major impact on local people.
	The downgrading starts with the downgrading of paediatric services. The sadness of the matter is that long ago in 1974 a young boy from Bloxham, a village just outside Banbury, died. The then Secretary of State, Barbara Castle, ordered an independent inquiry that found that there should be 24/7 paediatric services at Horton general hospital to serve the wider catchment area. Under the proposals, we will effectively go back 30 years to the period before Barbara Castle's decision. The knock-on effect of not providing 24/7 paediatric services is that one can no longer provide obstetric services, because there is no special care baby unit, yet we are proposing to set up the largest midwife-led maternity unit in the country.
	The consequence of the proposals is that 58 GPsI hope that the House takes note of that numberhave collectively made a submission to the Oxford Radcliffe Hospitals NHS Trust, in which they say in excoriating terms that the proposals are unsafe and inhumane. The GPs make excoriating criticism, too, of the fact that the consultation has been carried out with total disregard for any medical or professional consideration:
	Local services for children are the key issue around which many other services hinge. They have a significant impact on the viability of other hospital departments especially maternity and accident and emergency.
	It is evident that paediatric emergencies such as meningitis, septicaemia, respiratory distress, and serious poisoning may all incur dangerous delay in receiving appropriate care if the nearest paediatric department is an hour away.
	Serious, life-threatening illnesses do not confine themselves on the working day.
	On maternity services, the GPs say that
	under the proposals, mothers who required unexpected medical care during birth would need rapid transfer to Oxford...This would carry significant risk and would be inhumane.
	Even on the trust's own figures, a very large number of mothers who elected to have their babies at the Horton hospital would have to move to the John Radcliffe hospital in Oxford during labour. That is wholly unacceptable in the 21st century.
	The issue is of concern to all political parties locally. Indeed, the Keep the Horton general campaign, under the excellent leadership of local Labour councillor George Parish, is supported by people from every single political party. Thousands of people marched through Banbury and rallied in the local parks in support of the issue, which is a completely cross-party concern. It is not surprising that, without dissent, Cherwell district council, said:
	The proposals in the consultation document potentially put patients at risk, fail to deliver the aims of the ORHT
	that is, the Oxford Radcliffe Hospitals NHS Trust
	are contrary to current Government Policy, place an unnecessary cost burden on the local population and in no way meet the needs of the local community now or in the future, as such they are wholly unacceptable to this Council.
	They are also wholly unacceptable to the people whom the Horton general hospital has served for the past 150 years. Local people are determined to do everything they can to ensure that the Horton hospital remains a general hospital.
	I also hope that Ministers will recognise that the Oxford Radcliffe Hospitals NHS Trust has failed to carry with it any medical opinion. GPs can speak publicly, and they have done so collectively. But another concern that I wish to draw to the attention of the House is that many of those who work for the trust have felt unable to speak openly because of potential disciplinary and other pressures. During the summer I had a number of meetings with consultant specialists at the Horton and the trust, but they wanted to have them away from the hospital, and in private. I asked them, Why on earth are you unwilling to speak on the record? They replied that they feel that they would be discriminated against as a consequence. That is wholly unacceptable. The last time I had meetings of that kind was when I talked with dissidents in eastern Europe before the fall of the Berlin wall. That should not be happening when people are talking about reorganisation of general hospitals in the 21st century.
	The proposals will lead to the downgrading of an excellent general hospital to such an extent that it will no longer be a general hospital in the way that people understand what a general hospital is; it will be merely a collection of medical services. The proposals are completely friendless and completely unsupported by medical opinion locally.
	I very much hope that in due course the overview and scrutiny committee of Oxfordshire county council refers the proposals to the Secretary of State, and I hope that the very least that the Secretary of State will do is refer them to the Independent Reconfiguration Panel. But I would also hope that before then Ministers will have the nous to wake up to the fact that 58 GPs are opposed to the proposals; there is not a single dissenting GP in the entire area served by the Horton general hospitalthere is not a single voice supporting the proposals. In the face of such widespread medical opposition, it might be sensible for the Department to intervene, and to suggest to the Oxford Radcliffe Hospitals NHS Trust that it should think again about this matter and seek to ensure that we keep the Horton general a general hospital.

Kitty Ussher: I welcome the opportunity to speak in this debate. I also welcome the fact that the debate has been secured on an Opposition motion because there are a number of questions that the Opposition need to answer about their policies and their record, and the public should hear those answers. Therefore, I have a number of questions for them.
	However, let me first talk about our record. As we have heard, NHS spending under this Government has trebled after inflation, from 30 billion to 90 billion.

Graham Stuart: It has doubled.

Kitty Ussher: No, it has trebled in real terms. I thank the hon. Gentleman for his sedentary intervention, but it will very shortly have trebled in real terms. The number of doctors has risen by 32,000 and the number of nurses by 85,000. We are also meeting our targets on waiting timeswe no longer have the shame of front-page headline news of horrific waiting times stretching on for years.
	All of those are points of process. The desperately important issue, which we are not hearing about from the Opposition Benches, is that the survival rates and outcome rates are improving. That is what really matters. Under this Government, if someone has a heart attack, they are one third more likely to survive than they would have been under the Conservative Administration. People are also seven times more likely to survive cancer. People are living longer because of the changes that we have made, and will continue to make, in the NHS.

James Gray: The hon. Lady is making an interesting point, but would she accept the following two points? First, at least part of that greater survivability comes about as a result not of the Labour Government, but of developments in medical science that would anyhow have extended our lives, and secondly, even so, our survival rates are significantly lower than those of the whole of the continent of Europe.

Kitty Ussher: It will not surprise the hon. Gentleman to learn that I do not accept his argument. I agree that medical science advances, but that is because we fund medical science; it produces drugs that cost money, and we are spending the money. It is not inevitable that survival rates improve. Mortality rates are rising in some countries and I am extremely proud that we are not one them, because of the work that Labour Members are doing.

Greg Clark: Can the hon. Lady name a continental European country where mortality rates are actually rising?

Kitty Ussher: I do not know the figures for every country, but I am happy to talk to my colleagues on the Public Accounts Committee about this issue later.
	How have we achieved these improvements in outcomes in the NHS? There are three factors, the first of which, of course, is the money. It is not by chance that these improvements have happened. On listening to some of the contributions from Conservative Members during this debate, one would think that we have somehow magically profited from benign economic circumstances and that, had they been in the same situation, they, too, could have done it. It is our economic policies that have led to this situation, but most importantly, we raised taxes, which Conservative Members opposed, to do it. This is not chanceit is deliberate action.
	The second way that we have achieved our outcomes is by setting targets. We have not just thrown money into the systemthe Government have sent an extremely clear signal about what we want devolved management to spend that money on. I hope that the Conservative Front-Bench spokesperson will say later which of those targets they would cut, given that they are on record as saying that they would do so. Would they cut our target of a mere 18 weeks from GP referral to actual operationdown from 18 months under the previous Government? Would they cut our target of seeing accident and emergency patients within four hours, which is practically being met, I am proud to say, in my constituency? Would they cut our target to have urgent cancer cases seen by a specialist consultant within two months, which I believe is also largely being met in my constituency? We need the answers to those questions because these are the issues that matter to the public; yet the Conservatives say that targets do not matter to them.
	The third reason why we have achieved improved outcomes is, yes, reform and change: doing things in a better way than we have done them before. We can all debate the individual issues in particular constituencies, and it is right that we keep the pressure on to make sure that we get it right in our own areas. I support the efforts of my hon. Friend the Member for Pendle (Mr. Prentice) in that regard, and I will join him tomorrow to ensure that we get our local overview and scrutiny committee to refer to national Government the decision to downgrade Burnley general hospital A and E.
	My question to the Opposition is this. You say that you oppose reconfigurations. Let me put this to you. What would you do if that reconfiguration was leading to better value for money for the taxpayer?

Madam Deputy Speaker: Order. I should remind the hon. Lady that I just sit in the Chair; this has nothing to do with me. The parliamentary term that she wants is Opposition Members.

Kitty Ussher: I stand corrected, Madam Deputy Speaker; thank you very much.
	What would Opposition Members do if the reconfiguration that they oppose on principle led to better care and better value for money?

Steve Webb: Will the hon. Lady give way?

Kitty Ussher: I have given way several times and I am afraid that I do not plan to do so again.
	What would Opposition Members do if changes in technology and in the way that services are delivered and hospitals run meant that more people were likely to survive? If new technology meant that it was possible to visit people in their own homes and give them the care that they need there, hypothetically speaking there would therefore be fewer beds locally. Would they oppose that, as they have said they would?
	We have achieved better outcomes for our constituents throughout the country, and longer life expectancy and better mortality rates, particularly in respect of cancer and heart disease. We will continue to achieve that by investment, by putting up taxesthe Conservatives opposed thatby setting the clear targets that they also oppose and say they would scrap, and by reform, which we clearly need to get right.
	I look forward to the Conservative Front-Bench spokesperson's contribution, because the public have some questions that need to be answered. I am grateful for this opportunity to put those questions, and I think that the public will see through, as I do, the attempt of Conservative Members

Steve Webb: Will the hon. Lady clarify her position on the important decision being taken in her constituency about local accident and emergency services? Who should make it? Local people or somebody in Westminster?

Kitty Ussher: On the whole, it is right for local trust managers to make decisions in their local area, but it is extremely important that the democratic system be made to work, so that where there are serious concerns about whether something is right the decision is referred to national Government and the Secretary of State. That is very much what I hope will happen. I would support other overview and scrutiny committees that took that view.
	We are seeing a callous attempt from the Opposition to try to hoodwink the public that they care about an institution that the public rightly hold dear. We have heard nothing today to make us believe that the Opposition have policies that could make the serious and sustained difference that Labour members and our Government have been making for more than a decade. I look forward to hearing the Opposition's response to the debate because I do not think they have answers to the questions we are posing.

Richard Taylor: I have been looking forward to this moment for a long time. I shall start by offering advicefreely given and well meantto the Government and in the second part of my speech I shall offer advice to the Government and to the Tory Opposition.
	First, what does service development mean? To me, it means improving and updating the service for the good of the patient: not for managers, not for staff, not for politicians, but for the patient. In the past 25 years, 28 reforms of the health service have been carried out by Governments of both colours. They were well described as debilitating changes by the hon. Member for Pendle (Mr. Prentice), and they were decried by the hon. Member for Bedford (Patrick Hall) and by the right hon. and learned Member for Rushcliffe (Mr. Clarke), so I shall not spend much time on them.
	The crucial thing is hospital reconfiguration, which obviously strikes fear in the heart of many MPs because of what happened in Kidderminster so long ago. If anyone knows how not to set about reconfiguring hospitals it is me, so I offered the benefit of my advice to the chief executive of the NHS, whom I know vaguely. I thought that I would receive no reply, but this morning I had a letter from him saying that he would like to arrange a meeting. So it seems that he wants to take my advice, which is superb. Perhaps the Government realise that as an Independent I am not automatically against them all the time and that sometimes I can help.
	There are signs that the Government are beginning to remember the lessons they have learned since Kidderminster. We have heard much about overview and scrutiny committees today and a little about the independent reconfiguration panel, the crucial body set up by the Government to ensure independence in the reconfiguration process and to take it out of the political arena. It is essential that they use the panel.
	The Government's record so far is pretty abysmal. Until March, there had been eight referrals from OSCs to the Secretary of State, but only one to the panel. Yesterday, other members of the all-party local hospitals group and I met the chair of the IRPa tough, no-nonsense GP from Nottinghamwhom I would back as thoroughly independent. We heard several things. Perhaps the Government's record is improving slightlythere have been 18 referrals to the Secretary of State and four have got through to the IRP. Furthermore, we heard that the panel has the promise of money so that it can expand to cope with the work as it comes in. The Government have realised the importance of that and in this day, when there appears to be no money for anything, there appears to be money for this absolutely vital panel. I hope against hope that we now have the proof that the Government are beginning to listen and to realise that using the independent reconfiguration panel will take the politics out of it all. It is no good having the Government tsar for emergency services come up with an independent review. With all respect to the Government tsar, he is paid by the Government and cannot really provide an independent view, yet having such a view is crucial.
	In the document, Keeping the NHS Local, the Government showed that they were learning lessons about consultation. For example, it states that consultation
	with patients and the public, and with staff, needs to begin right at the outsetbefore minds have been made up about how services could or should change.
	One of the document's core principles is
	developing options for change with people, not for them.
	Even the Secretary of StateI am sorry to put it like thatwas reported in  The Guardian on 20 September as saying:
	The exact configuration must be determined locally by clinicians, ambulance staff and patients.
	That is brilliantno mention of managers, executives, the Government or politicians, but only of
	clinicians, ambulance staff and patients,
	which is exactly how it should be. I only hope that the Government will stick to that.

Steve Webb: As ever, the hon. Gentleman is making a thoughtful contribution. May I take him back to the independent reconfiguration panel? Does he accept that it is very much a second-best world, whereby local people who have a problem can go for the mercy of the Secretary of State, who may or not appeal to a group of people who were not elected in the first place? Is not that less satisfying than what he referred to previously: local people taking local decisions?

Richard Taylor: I am grateful for that, because it allows me the opportunity to clarify what the independent reconfiguration panel is now doing. Because it has been used so little by the Secretary of State, it is putting itself forward as an advice service early on in the process, before an issue goes to formal consultation, thereby bringing together parties from both sides in order to broker a compromise. Time and again, compromise will prove essential.
	To clarify my position, I reluctantly have to accept that we cannot keep every acute district general hospital doing everything in every town. The European working time directive, changes in practice, the move to primary care and the existence of financial deficits make that impossible. However, I will never accept that what happened at Kidderminster was right or should ever happen anywhere else. As hon. Members will know, we lost everything that makes an acute hospital an acute hospital. We lost in-patient medicine, in-patient surgery and hence, of course, the accident and emergency department.
	Things have changed tremendously since 2000, when that happened. At that time, one could not maintain acute medicine without retaining all of emergency surgery. Now, it is accepted that even if emergency surgery is lost, it is possible to keep acute medicineadmissions for heart attacks, strokes, pneumonias, bread-and-butter emergencies and so forth. It is now well understood that in any A and E department, the bulk of emergencies requiring admission are medical and not surgical. In Keeping the NHS Local, the Government produced some models of the downgrading of hospitals that are far less severe than what happened at Kidderminster and that have been accepted by local people. One need mention only Hexham and Bishop Auckland, where emergency medicine was kept, even though emergency surgery was lost. They were able to keep what are called urgent care centres, which are a jolly sight better than the minor injuries unit that is all that Kidderminster has left.
	My plea to the Government is to use the independent reconfiguration panel and, as an aside, to standardise what is meant by emergency departments in our acute hospitals, as was done in the Northern Ireland acute services review of June 2001.
	My second piece, which I must rush through, is that morale among the work force is absolutely desperately low, not only because of continued change, because of fears about jobs and partly because of deficits, but because of the rush to privatisation. It has suddenly come to me what the Conservative party and the Labour Government regard as privatisation, and it is not the same as what most of us who worked in the NHS and most other people think. To the Government and the Conservative party, so long as the patient does not pay, we have a national health service.
	People who work in the NHS and the bulk of the patients to whom I talk have a high regard for uniformity of provisionat least, in the acute hospital service, if not across the whole NHS. I absolutely take the comments of many hon. Members on both sides of the House who have pointed out the hefty involvement of the private sector. Uniformity of provision was what Bevan produced. By introducing common pay scales right across the whole country, he immediately made it just as satisfactory for the best doctors and nurses to work out in the country as in London. By privatising some of the providers, we are risking a great deal of the real good that is in the NHS, and that will be one of the battle grounds in the future.
	I do not believe that we should have an independent body running the NHSthat should be left to clinical and managerial staff close to the patients on the groundand that is why I am so glad that the Healthcare Commission is assessing not only how to fulfil targets, but how to assess outcomes. I cannot wait to read the comments that will come out in the next 24 hours or so.
	I have looked at a large number of hospitals, and the crucial thing is the standard of the medical director and of the chief nursing officer. If they are of the right calibre and are prepared to get out and about to see what is going on, they can pull up the standard of care. The posts of those whom the Healthcare Commission decides are sub-standard should be examined very closely.
	I have run out of time. I believe that the rush to privatisation might even galvanise people who did not have a previous political interest to take up the sword, rather as I have done, on the issue of abnormal, unwise hospital downgradings.

Roberta Blackman-Woods: This is an important time for the NHSchange is never easy or straightforwardand I should like to think that the Conservative party had called this debate to help us with our deliberations and to engage constructively in a discussion about the future of the NHS. After listening to much of what has been said today, however, I fear that the debate is simply opportunistic and an attempt to exploit some of the difficulties and challenges that are associated with change.
	Figures that were published by the Department of Health earlier this week show that health inequalities still exist and that health outcomes for people in the north are still poorer than in the south. In the north-east, where my constituency is located, life expectancy is lower than in other areas of the country and people are still dying prematurely from cancer and circulatory diseases. Although there have clearly been huge improvements in the NHS, they have not been good enough. It is important to note that Labour Members recognise that improvements must still be made, and a number of Department of Health documents, which I will talk about later, recognise that fact and set out a strategy to address those needs.
	We need better diagnostics and quicker treatment. People need to be not only more aware of lifestyle facts, but to act on them. We need greater community support for lifestyle changes, because some of the communities that we are talking about are extremely vulnerable, with very vulnerable people living in them, and they need support to make changes.
	We also need a much greater availability of a range of low cost sport and leisure services and, to this end, I am disappointed that the Liberal Democrat council in Durham has chosen to build its new swimming poolwe all applaud it for doing thatin the most affluent area of the city and ignored the deprived ex-mining villages. That will not help us to reduce the health inequality gap.
	Although challenges remain for constituencies such as mine, I want to recognise the improvement in local services. We have a new hospital in Durham and it is doing extremely well at meeting the Government's targets. The figure is 100 per cent. for all out-patient services and it is 100 per cent. for more than half of in-patient services. Things are getting better for the people I represent. We are now close to an 18-week waiting list for all services.
	We should also note in passing that the quality of information that we now have about what is happening in our local hospitals and GP practices is excellent and enables us to see what is going wrong in a way that certainly never happened under the previous Government. A Conservative Member said that there was greater anxiety now about what was happening in the health service, but I dispute that not only because things are much better, but because there would have been huge anxiety under the previous Government if people had actually known what was happening to health services.
	In terms of service development in Durham, we have the new hospital and new mental health services, which have not been mentioned much in the debate. Such services are critical but, in Durham under the previous Government, they were left to languish in an old Victorian hospital with no investment whatever. We are now getting a new mental health facility with acute and community-based services. Our PCT reconfiguration will also help to deliver partnership working with the local authority across a range of services.
	I also want, however, to refer to some of the challenges that remain. In Durham and other areas, the Government have recognised that we need a shift to more community-based services. Many more people want to have services at home or in their local community if that is at all possible. I pay tribute to the Government for producing three documents that address some of these issues. They are Health Challenge England, which was published earlier this week and gives detailed information on health inequalities and the problems that still need to be tackled; Our health, our care, our say: a new direction for community services, which looks at involving local people in making decisions about their community; and Choosing Health. Those documents are important because they help us to look at challenges resulting from demographic and technological changes and from what is happening to consumer awareness and consumer demand.
	The documents also consider several professional issues and that leads to a key point. Money needs to be directed at reducing inequalities in health and that means directing money to the areas where it is most needed. I have sat on these Benches for many debates and many Question Times listening to Conservative Members trying to defend primary care trusts that have not lived within their budgets and that seek to obtain subsidies from areas such as the one that I represent where there are poor health outcomes.

Grant Shapps: Will the hon. Lady not concede that whether a primary care trust does or does not meet its target is at least in part due to the amount of money that it was given in the first place? It is conceivably possible that the guidelines that work that out are unfair in many ways.

Roberta Blackman-Woods: Perhaps the hon. Gentleman would look at the primary care trust in Durham, which has enormous health challenges, as I outlined, yet manages to live within its budgetso it is possible. To return to my point, difficult decisions have to be made and if health inequalities are to be addressed, money has to be directed towards areas that need it most and that have the poorest health outcomes.
	We also need a degree of local commissioningthat is also addressed in the documentsso that local factors can be addressed. We need greater local delivery and accountability, and we are having discussions about how that can best be achieved. That is critical for constituencies such as mine where there are remote, sometimes isolated ex-mining villages that need local services.

John Baron: We all agree that better community services are needed, but how can the hon. Lady square her comments with the fact that community hospitals are being closed by the Government, the number of district nurses is in decline, and one in 10 birth centres are apparently close to being closed? That is not a sign of a Government who are willing to commit greater resources to community provision of health care.

Roberta Blackman-Woods: I hope that the hon. Gentleman accepts that the situation varies across the country and has a great deal to do with how effectively resources are managed. I will give him an example. The acute trust in Durham is considering how it can reduce some of the acute services where there is overcapacity and shift those resources towards primary care services. I hope that that will lead to better treatment services in local communitiesthat is what has to happen. It is a difficult decision, and I have had to argue for it locally because the local press and opposition are trying to make out that that means cuts. It does not; it is about planning for the future and reconfiguring according to need. We on the Labour Benches have started a very important debate.
	Given that the Conservatives called today's debate, I thought that I would look at their website to see what policies they are producing to address the issues. I consulted The Wellbeing of the Nation, a public service improvement policy group publication from autumn 2006. I hope that that is recent enough for Conservative Members. The first thing that I discovered was
	Policy-makersof all parties
	apparently
	have too often fallen into the trap of implying that employment in the professions is 'just another job'. We believe this approach fatally undervalues
	the professions working in the health service. That may be the Conservatives' belief, but it is most certainly not the belief of those on the Labour Benches. We have always valued people who work in the national health service, and I pay tribute to those who do so in my constituency.
	I also looked at the Leader of the Opposition's weblog, where he tells us about news of the health service and that reorganisation in the health service must stop, with which I agree with himwe need a period of stability. However, the very first point in the document says:
	Are the present structures within the clinical professions capable of performing the roles..? If not
	should they be amended? It continues:
	Are the present structures within the NHS capable of performing the roles envisaged...in this partnership?
	If not, it asks, should there be amendments?
	Conservative Members are not even addressing the challenges that they are setting for themselves. I would like to hear from them how they will achieve the move from acute to primary services. How will they deal with rising expectations? How will they keep the NHS safe if they commission from the independent sector? We have heard it acknowledged this afternoon that all services could be commissioned from the independent sector. How would the NHS be safe with them? My constituents know from their experience that the NHS is safe with us, not with the Conservative party.

Several hon. Members: rose

Mr. Deputy Speaker: Order. It is too late to invoke the short speech rule, but may I suggest to hon. Members, about 10 of whom would like to catch my eye, that they operate on the basis that the rule was invoked, in which case the tariff would be about five or six minutes per speech?

Graham Stuart: It is my good fortune to have you in the Chair making that announcement just as I rise to speak, Mr. Deputy Speaker.
	I have enjoyed today's debate. Thoughtful speeches have been made by hon. Members on both sides of the House. Some Labour Members have not read an entirely Labour party-oriented script, but have examined some of the issues and problems. That is surely what we all should be doing. As Conservative Members have said, a consensus is emerging on the way forward for the NHSa consensus on making the best use of the resources that we have. The hon. Member for Bedford (Patrick Hall) in particular picked up on the present financial shortcomings.
	The Labour Government inherited the most powerful economy in European economy that had been transformed by the Conservatives after years of socialist failure. As Labour Members are fully aware, this country had become the fourth most competitive economy in the world. Labour's sick man of Europe had been converted from a basket-case into a model envied and, indeed, copied in equal amounts by others.

David Taylor: Will the hon. Gentleman give way?

Kitty Ussher: Will the hon. Gentleman give way?

Graham Stuart: NoI have only five minutes and hon. Members are stretching credulity if they think I will give way.
	There is more to life than economics, however, and the British people wanted world-class public services, not just a world-class economy. Labour's victory in 1997 was achieved on the basis that a Labour Government would accept Conservative economic prescriptions but use that economic strength to make our education and health systems world class, too. As my right hon. Friend the Member for Charnwood (Mr. Dorrell) said, it is greatly to the Labour party's credit that it reflected public opinion and the public's desire for world-class public servicesa desire for spending to increase to the European average. The measures taken at that time were opposed by the Conservatives, but my party has listened to the British people and recognised the need to change, and it is doing so.
	There has been a doublingnot a trebling, as one hon. Member saidof spending on the NHS in real terms since Labour came to power. Sadly, however, outputs and the outcomes for patients have not matched the massive increases in resources. In the 1997 manifesto, Labour promised to be
	wise spenders, not big spenders,
	but Ministers admiteven the Secretary of State has done so, albeit not today in her rather weak speech, which did not match the strength of many Labour Members' contributionsthat outputs have not increased in line with increases in resources.
	We have heard a great deal about acute hospital performance. In the six years to 1997, the number of hospital treatments in the NHS increased by 26 per cent. Productivity was improving sharply during the 1990s.  [ Interruption. ] If the hon. Member for North Durham (Mr. Jones) will allow me, I am trying to address the root of the problem. There is a consensus about the broad approach, and we as a Parliament and as politicians need to work together to find a way forward. In the six years after 1997, however, there was only a 14 per cent. increase in hospital treatments, and according to the Office for National Statistics, productivity in the NHS has fallen by up to 1.3 per cent. each year since 1997.
	Labour Members can take credit for the massively increased expenditure on the NHS, and there have been improvements in standards as a result of that investment; those points are valid and they deserve to be made. However, falling productivity means that that expenditure has not brought value for money for the UK public. The Secretary of State for Health said earlier this year:
	For all the extra money, all the extra staff and extra patients treated, NHS productivity has remained almost unmoved.
	The truth is that it has moved: NHS productivity has fallen under Labour. That is the central problem.
	I and many of my colleagues broadly support the vision set out in the White Paper at the beginning of this year. It is the disconnection between that vision and the reality on the ground that we are discussing today. Ways must be found to address the problem of falling productivity that has been recorded under the Government and to overcome it. I hope the Government will be able to make improvements. Although that will be less politically advantageous to us at the next election, I hope there will be serious productivity improvements by then.

David Taylor: rose

Graham Stuart: I will not take any interventions, after the words of the Deputy Speaker.
	If the Government had merely maintained the progressadmittedly, with much lower resourcesof the last Conservative Administration, 1.4 million more people would have received hospital treatment under the Labour Government. Waiting lists, instead of being massaged, would have been banished. The hon. Member for Bedford described the financial arrangements of the NHS as bizarre, confusing and damaging and said that the resource accounting and budgeting must be sorted out.
	Labour has failed because it has not delivered value for money. For all the billions that have been spent, 1 million people still remain on waiting lists, which none of us in the House wants to see. Health inequalities have been mentioned several times. I do not want to be rude to Labour Members, but there seems to be a certain level of complacency about the fact that health inequalities are at their widest since Victorian times and 10 community hospitals have closed in the first six months of this year alone.  [Interruption.]
	The debate is very much about staff. My colleagues are urging me on. I thought they were urging me on in my speech, but I now realise that they are urging me to stop so that they can speak, so I shall conclude, in deference to them, with a letter that was delivered to the Prime Minister two days ago. It is signed by the general secretary of the Royal College of Nursing, the chief executive of Diabetes UK, the chief executive of the National Rheumatoid Arthritis Society, the chief executive of the MS Trust and the executive director of Incontactwho, I hope Labour Members will accept, are not a group of Tory stooges trying to make political advantage for its own sake. The letter states:
	Now the very people who have delivered your reforms are among the thousands of NHS staff who are at risk of redundancy. A culture of fear and uncertainty has permeated the health service. Nursing staff are worried about their futures and have become increasingly concerned about the safety and welfare of their patients, whom we believe are at serious risk from the actions which Trusts in deficit are taking to save money.
	That is the position that we are in. We all need to work together to sort it out. Moves to stop the meddling from the centre and to provide an independent board for the NHSthe prescription proposed by the Conservative partywill make the difference. We will work with the Government while they remain in office to try and improve the NHS. I hope all sides will work together on it.

Meg Hillier: This has been a rather surreal afternoon, perhaps because it is nearly six hours since I came into the Chamber and I have not had lunch. It was odd for me to sit opposite the right hon. and learned Member for Rushcliffe (Mr. Clarke), who is no longer in his seat. It seems not that long agoa little longer than I would like to admitthat I was studying him and his Government at A-level. During parts of the debate, one could be forgiven for thinking that we were living in the 1970s and 1980s.
	But reality bites, and in my constituency, reality bites about what has happened in the NHS since the Government have been in powerthe rapid investment. I shall respond briefly to the comments of the hon. Member for Beverley and Holderness (Mr. Stuart). Perhaps he does not understand the basic economic principle that if one pays people what they are worth, which is more than they were being paid in 1997, productivity will indeed go down. We still need to do more, but he does not seem to have grasped that. On health inequalities, he is rude about all of us, but he is wrong. There is no complacency among Labour Members about health inequalities. I have little time, but I shall touch on some of those health inequalities in Hackney.
	Hackney's health services are being transformed under the Government. One leading local health professional said:
	The NHS has done fantastically well under this Government and any current concerns must be couched within this context.
	In fairness to the excellent health professionals in Hackney, South and Shoreditch and Hackney borough, I want to give just a few examples of good service development in my constituency. I do not have time to deal with all the indicators, but hon. Members will know from previous comments that I have made in this House that Hackney has many health challenges.
	We have an excellent foundation hospital in the Homerton hospital, which is ahead of the game on a number of counts, but particularly on connecting for health, the computerised IT programme. We already have a comprehensive electronic patient record service, in the vanguard of the rest of the NHS in IT innovation, and that is thanks to Government money.
	We have a primary urgent care centre at the Homerton hospital and more GPs and GP surgeries than ever before154 full-time equivalentsand their premises are constantly being improved, which was long overdue as many GPs were working from tatty terraced housing. Some still are, but we are working to improve that.
	We have two walk-in centres in the borough, one in Liverpool street near my constituency and one in Hackney, North and Stoke Newington in Stamford Hill. Practice-based commissioning is advancing, with 39 practices now thinking carefully and enthusiastically about how they can use that to improve patient care, because they put patients at the centre.

Graham Stuart: U-turn.

Meg Hillier: No, that is a very different model. It is putting GPs in the driving seat on patient care, where most people have their first, and last, contact with the health service. It is not differential funding, and that is important to remember. There is no sweetener for people trying to take a different route and opt out of the NHS. They are working with hospital doctors to ensure closer care and for more of it to be provided at GP surgeries. For many of my constituents, just getting to the hospital, even though it is very local compared with those of many hon. Members, and having a local, safe, known environment means that there is a much greater chance of them getting the treatment that will prevent some future health inequalities. Flu jabs are well organised, with pharmacists in Hackney also providing them. It has never been easier to be immunised in Hackney.
	The Homerton hospital is our local district general and for 11 years, since its inception, it has had no deficit. In fact, for most of that time it has had a surplus. Last year, it had its first small deficit but it was less than 1 per cent. Much of the talk about deficits has suggested that they are a widespread problem, but in fact only a small percentage of trusts

Martin Horwood: Cheltenham and Tewkesbury primary care trust had also never had a deficit, but it has not saved us from the cuts. The fiction that they affect only a minority of trusts has nothing to do with the configuration of the deficits. Shared services and other factors are causing that.

Meg Hillier: If I have time, I will come to some of the issues in my local area.
	This year is a more challenging one for my local hospital, largely because it is very dependent on emergency admissions, and the tariff for that is much lower than those for other treatments. It is unusual for a hospital to have the high level of emergency work that the Homerton has. That is partly due to the nature of the area where many people still present at hospital as a first option rather than at primary care level.
	Recently, I met the chief executive and she knows that times are challenging as she manages this change, but she is positive that the changes that she is making are clinically driven and are leading to innovative best practice. That is a big priority for her and her clinical team. Next year will be hard because those savings need to be found in that year, but the future is looking more stable. I have great faith that the future will be much more like the last 10 or 11 years, when the budget was balanced. It is down to good management, adjusting to change in the interests of patients, and good financial managementthere and in the primary care trust, which also has always had balanced budgetsis important.
	This debate is supposed to be about service development, so I want to deal now with mental health, which is a big issue in Hackney. People in Hackney are diagnosed with schizophrenia more often and admissions to hospital for schizophrenia are three times higher in Hackney than they are in England. The borough has unusually high rates of illness across the mental health spectrum. The factors are many and I do not have time today to go into them, but in terms of future service development, the Government's focus on delivering race equality in mental health is very welcome and pertinent to Hackney, South and Shoreditch.
	Of those sectioned, 44 per cent. are black men. They make up only about 5 per cent. of the total population, but that is an incredible anomaly that we need to tackle. There are good examples of what can be done, and some are not just about services in hospitals, or even in health facilities, and I want to highlight a couple.
	The Hackney football team has been run for the past two years by an occupational therapist who is also an accomplished footballer. The players in the team have all suffered mental health problems. Now, all but one of them is not smoking, three have coaching badges and one has a full-time job. It is clear that that team has helped those people to get back on track and into normal life.
	The 4Sight group involves users of the City and Hackney centre for mental health. Its members work with a drama group to develop plays about their experiences, which are now being used to train staff. The Government can learn from that experience with regard to the rest of the country.  [ Interruption. ] I hope that hon. Members are listening and that they will take that point back to their mental health trusts.
	Language and access to health services is a big issue in my constituency, and it is as important in mental health as it is in other areas. I commend Derman, which is a bilingual health advocacy service to the Kurdish and Turkish communities, to Ministers. It enables those communities to access a range of mental health services, and it helps to reduce hospital admissions and health inequalities, which I have not had time to discuss today. It is vital that we look at the differences between areas.
	Some Opposition Members have unfairly described Government Members as complacent. We know about the difficult circumstances in which people live, because we see those people in our surgeries and in the streets.

Graham Stuart: And in ours.

Meg Hillier: The hon. Gentleman keeps intervening from a sedentary position and I am taking up time that might have been given to other hon. Members by responding to him. He would be shocked to see how people live in my constituency and the difficulties that they face in accessing services.
	The PCT is continuing to invest in mental health year on year. We need more talking therapies at GP surgeries and more preventive work. Employment support is also important, because only 21 per cent. of people with mental health problems are in employment, which is a shocking indictment that we need to examine across Government. I recently met clients at Hackney Mind, who discussed the need to have time to get back into workmost of them want to get off incapacity benefit or ill-health benefit and back into work.
	I have mentioned that Hackney PCT and our foundation hospital, the Homerton, have good financial management. Last year, however, Hackney PCT had to passport its underspend to overspending PCTs in other parts of London, where average male life expectancy is a couple of years greater than that in Hackney. To our consternation in Hackney, on top of losing that surplus, which could have been invested in the services that I have highlighted, the PCT has been asked to give still more money to trusts that do not balance their books in the short term. I shall make no bones about itwe in Hackney are very angry about that.
	Why can budgets not be balanced elsewhere when they can be balanced in Hackney, which faces enormous health challenges? The Secretary of State for Health has promised me in a written answer that that cash will be returned, and I ask Ministers to underline that guarantee. We in Hackney do not want to go to the barricadeswe want the money backbut we are becoming cross about subsidising organisations that are less well financially managed. I am interested to know what further action Ministers are taking to ensure that good financial management is a prerequisite for any PCT or foundation hospital.

Anne Milton: I share the disbelief and incredulity expressed by many of my hon. Friends when they listen to Labour Members. At times, it feels like we are living in parallel universes. The truth of the matter is that we are both right. Many constituencies represented by Labour Members are getting considerable funds, which means that those constituents and the doctors and nurses involved are very happy, but constituencies represented by Conservative Members are not getting such good funding.
	A lot of research has been conducted on the funding formula, and it indicates that the formula is not as fair as it should be. Conservative Front Benchers have introduced the possibility of separating funding for disease and funding for public health, which would allow us to have an impact on health inequalities. Despite the protestations of Labour Members, who go on and on about health inequalities, and despite the huge increases in investment, health inequalities are getting bigger. The situation has got no betterit is absurd.
	In my constituency, the Royal Surrey County hospital, by the Government's standards, is an example of excellence. It employs 2,300 staff, including 280 doctors, 800 nurses and midwives and a multitude of therapists and scientific and support staff. It is a success story both in the care that it delivers to patientswith a top-performing accident and emergency department, waiting times for surgery met, 100 per cent. compliance with cancer waiting times and the joint lowest mortality rates in Englandand in the way that it develops its staff. It offers outstanding development opportunities for its staff, with 96 per cent. receiving training. The focus on staff welfare is demonstrated by the job satisfaction experienced by staff. As my hon. Friend the Member for Mid-Sussex (Mr. Soames) commented, however, the strategic health authority is undergoing a review of acute services.

Jeremy Hunt: Is my hon. Friend concerned that the SHA's review seems to have been fixed before it has even started, given the comments by the chief executive of Frimley Park hospital suggesting that there is a shortlist of hospitals, and that the Royal Surrey has already been designated as one of a shortlist of two hospitals in Surrey that are likely to be closed?

Anne Milton: My hon. Friend is right. There is huge cynicism about the consultation exercise. Proposals were meant to appear in the middle of August. That was then put off until the middle of September, and then late October. We now hear that the proposals will not come forward until the beginning of December. As the debate is about the work force and how we look after and value them, it is appalling that the Government can sit back and let such exercises go on and on while staff face huge uncertainty about their jobs.
	Let me say to those on the Government Front Bench: we are not making this up. The Royal College of Nursing is not making it up. The British Medical Association is not making it up. It is true, it is real, and I challenge any of them to come down to Guildford to a public meeting and listen to clinical staff. Jobs and acute services are going and the future of the Royal Surrey County hospital, along with that of other hospitals in Surrey, hangs in the balance, because we do not have adequate funding.

Humfrey Malins: My hon. Friend will know that St. Peter's hospital at Chertsey is also under threat. It provides a vital service to Woking constituents, is well placed geographically and has a wealth of experience. Does she agree that, were we properly funded, none of Surrey's great hospitals need close at all?

Anne Milton: My hon. Friend is right. Significant research suggests that rural areas, and areas with a high percentage of elderly people, are underfunded.
	The Government can act now and stop this. The way that I see it, hospital staff, the public and the Government are on a collision course, which is starting in Surrey and Sussex. The new chief executive of the NHS made it absolutely clear that he wants to see 60 acute trusts close. He wants more care delivered in people's homes, and that aim and vision is not inappropriate but, as ever, the closures will happen before the investment is put in. In a place such as Surrey, and for my constituents in Guildford, travelling times to accident and emergency could increase to as much as 70 minutes.
	It would be awfully nice if the Secretary of State listened to me for a minute and took some notice of what is going on. Clinicians, GPs and respected hospital doctors have told me that people will die if our accident and emergency departments are closed. The chief executive of the strategic health authority has said time and again that four out of five people can be treated outside A and E, but I still await an answer from the chief executive as to whom those four out of five people are. I contend that this Government will put lives at risk if they continue in their determination to close A and E departments and to downgrade our acute trusts, which also add to the huge research base in this country.

Diana Johnson: Listening to the debate for the past six hours or so, I have been surprised by some of the contributions. In particular, the hon. Member for Westmorland and Lonsdale (Tim Farron) said that he wanted an NHS that was just good enough, not excellent. That is certainly not what we want.
	I was also surprised to hear from the hon. Member for Beverley and Holderness (Mr. Stuart), my near neighbour, that if the Tories had got back in 1997, the huge waiting lists would have somehow disappeared into the ether. That is certainly not the general view. We needed to put the targets in place to ensure that the waiting lists were dealt with.
	I am pleased to be able to make a short contribution to the debate today, because I want to say something specific about 1997. I shall not rehearse all of our fine achievements since 1997, but in those days I was a member of the Mental Health Act Commission. I was appointed by the hon. Member for West Chelmsford (Mr. Burns), and I visited very vulnerable people who had been sectioned and placed in psychiatric units in the south-east of England. I saw for myself the under-funding, the poor state of the buildings and the lack of investment, which was because mental health services were such a low priority for the Tory Government. I am very proud of what the Labour Government have achieved since 1997, especially in mental health services.
	The right hon. Member for Charnwood (Mr. Dorrell) commented that he did not believe that Labour Health Ministers could talk the talk and walk the walk. I fundamentally disagree. The NHS 10-year plan showed clearly that our Health Ministers were talking the talk and walking the walk from day one. The right hon. and learned Member for Rushcliffe (Mr. Clarke) criticised the Agenda for Change, introduced by the Labour Government, but I am proud that we dealt with the poverty pay in the lower NHS pay scales. I remember watching the news as I grew up, with nurses talking year after year about how they were not paid properly. Labour has introduced proper pay scales and rates for nurses. We have also developed the nursing profession through nurse consultants and the introduction of modern matrons. We have an enormous amount to be proud of.
	Hull is one of those areas that has massive health inequalities. Listening to the debate, it struck me that several of my hon. Friends whose constituencies also have high levels of health inequalities said that their PCTS and acute trusts are managing their budgets and keeping within them, just as the Hull PCT has done. The East Riding PCTs did not keep within their budgets, but they serve a much more affluent, and therefore healthier, population than does Hull PCT. That is cause for thought.
	Hull is now a spearhead PCT and receives additional funding to address some of the deep-seated inequalities, and that is only right. I challenge Opposition Members to say whether that would be part of the Tory policy on the NHS. Would they continue the additional funding for spearhead PCTs?
	We have also seen massive investment in capital build in the Castle Hill hospital, which many of my constituents use. Some 65 million has been invested in a new cancer unit and 72 million in the surgical and cardiac units. The local improvement finance trust programme in Hull is providing decent community services and facilities for GPs, nurses, podiatrists and dentists. That is the right approach, and not a penny is being wasted.
	I hope that my right hon. Friend the Secretary of State will look at the Orchard Park LIFT site in my constituency. It is in a very deprived part of Hull, and unfortunately there has been a huge delay in getting the new facility up and running. It is vital to the local community that we get things moving as soon as possible.
	I turn now to the Hull and York medical school, the jewel in Hull's crown. It is very new but very popular, and I am proud that it is producing doctors for communities in Hull and east Yorkshire. Its students are often older than usual, and their socio-economic backgrounds are often different from those usually associated with people who go into medicine. The school is a very positive development in medical education, and provides a patient-focused approach to the training of doctors.
	I hope that the Minister, when he winds up, can reassure me about the funding of the Hull and York medical school, as concerns have been expressed about the local SHA taking control of the training budget. We must make sure that enough money is available to enable the students to complete their training and stay in our region.
	The NHS must adapt. It is a dynamic organisation, and we cannot afford to be static and to keep things as they are. The Opposition say that no change is necessary, but I totally disagree. The priority of managers in the NHS is always to be looking at how the service can be developed. For example, the Hull royal infirmary accident and emergency department has been transformed by the introduction of new ways of working, a different staff mix, and a new approach based on what works best for patients.
	Doctors and nurses at the Hull royal infirmary say that one problem is that people undergo the same diagnostic tests again and again. Putting that right will lead to more savings, but the point is that we must look at service reconfiguration and redesign to ensure that the NHS is fit for the 21st century. The matter goes beyond beds, bricks and mortar: we need to keep developing our community and LIFT facilities, and we must also look at the role played by midwives who were seconded into Sure Start children's centres, as it is very important that the NHS is taken out into the community.
	Hull's Doula project involves volunteers who work alongside midwives to give a helping hand to vulnerable mums-to-be. It is an example of how service innovation can use the talents of the voluntary sector, and an illustration of how we must think about health in its broadest context, rather than simply in terms of hospitals.
	I utterly disagree with the Conservative proposal to run the public health budget separately from everything else. That is completely the wrong way to go. We need to mainstream public health into everything that we do. I am very proud that the Government have taken a bold but correct approach to smoking, and we in Hull are leading the way by making sure that all children have access to healthy food every day that they are in school. We are also encouraging children to exercise by providing free swimming facilities.
	Public health provision is a long haul, and we will not see the benefits of the changes immediately. However, health inequalities will start to level out over the next 10, 20 or 30 years as we refocus on public health in a more effective way than has been the case in recent years.
	Finally, the Conservatives have argued for a massive expansion of social insurance schemes, voted against Labour's extra investment in the NHS, and said that the NHS should subsidise private health care. Therefore, their claims to believe that the NHS is important and that it is safe in their hands do not ring true. When the electorate look at the Tory Opposition's record, it is clear that they do not really trust them with the NHS.

Martin Horwood: I begin by declaring an interest. My wife works in my local NHS, so I must take particular care to praise the work and endless patience of local NHS staff, including those in the former Cheltenham and Tewkesbury PCT. The people there, just like their counterparts in the constituency of the hon. Member for Hackney, South and Shoreditch (Meg Hillier), did everything that the Government asked of them. They never had a deficit, with the result that the PCT was top-sliced. It was given a promise that it would get its cash back, but it has now been abolished. I hope that the new Gloucestershire PCT will do as well and survive longer. To be fair, I would also like to praise the extra investment that has gone into the NHS, which we supported. However, I have to acknowledge that, as the right hon. and learned Member for Rushcliffe (Mr. Clarke) said, most of the reasons for the current crisis lie in the mismanagement of that extra NHS finance at a national level, including things such as the over-commitment on GP and consultant contracts.
	The cuts and closures in Cheltenham are very serious. We face the loss of local adult mental health services; cuts in acute care; the decision to close a local rehabilitation hospital before any plan for providing those services elsewhere has been put in place; cuts in health visitors, community nursing, community dental services, patient transport and the prescription of drugs newly approved by the National Institute for Health and Clinical Excellence; and the loss of overnight acute in-patient child care, despite the promise one year ago that that would be saved, at least as a nurse-led unit. The consultation process that we have just been through made no difference to any of those things.
	One service has been partly salvaged from the wreckage. After 15,000 signatures and 10,000 people marching through the streets of Cheltenham, St. Paul's maternity unit has been savedat least as a midwife-led unit. Let us hope that that promise sticks. However, most of our local maternity serviceprobably some 2,000 deliveries a yearwill be lost and people will have to travel to Gloucester. The Government have even had the bare-faced cheek to claim public support for that policy. The health White Paper said:
	participants in the  Your health, your care, your say consultation said they wanted more care provided in community settings. The majority favoured increased investment in the latter, even if this meant changing the type and scale of services provided by their local hospital.
	Well, that is not quite what was said. On the same page of the White Paper, the citizens' summit consultation is quoted. The following question was asked:
	To what extent do you support or oppose providing more services closer to home, including community hospitals, if this means that some larger hospitals concentrate on specialist services and some merge or close?
	Only 15 per cent. of the people at the summit supported that in an unqualified way; 39 per cent. supported it to some extent. To find out which bits people supported, and what they were hesitating about, we have to go back to the consultation document Your health, your care, your say. Buried on page 112 of that document is the summary of the main findings of the consultation. The summary makes it clear that
	Most support moving hospital services into the community
	because
	They think services will be more accessible, because they are nearer to home.
	What were people hesitating about? They were quite clear. I quote from the Government's own document:
	They think the Government is proposing to close hospitals via the 'back door'.
	Let us consider the kind of journeys that were supposed to be avoided by providing services closer to home. Your health, your care, your say provides me with a local example. On page 114, it says:
	One participant gave the example of travelling from Cheltenham to Gloucester for treatment: a one-way taxi for that journey costs 35.
	That participant must be absolutely staggered by what is happening in Cheltenham. As part of the reconfiguration of services, obstetrician-led maternity care will cease, sending, as I said, some 2,000 expectant mothers on exactly the journey from Cheltenham to Gloucester that Your health, your care, your say said we would be avoiding. They will be making that journey along with their relatives and friends, the sick children going to the new overnight children's care service in Gloucester, the mental health patients going to the new adult mental health services at Wootton Lawn in Gloucester, and many others. It is quite clear that, although Labour was elected to save the NHS, what it is delivering for my constituents and many others across the country is less choice, not more, and health care further from home, not closer to home, and it is claiming support for both, when that support never existed.

Sally Keeble: I am sorry that I was not here earlier. I am grateful to have been called because there are difficulties in the health service in my area and I appreciate the opportunity to make a contribution. Like everybody else, I welcome all the extra funding that has gone into my local health services. I welcome the extra staff, the extra services, the proposals for a new acute hospital and the proposals for a new mental health hospital.
	I also welcome the new services and greater access that are available. For example, NHS Direct means that we do not even have to go to a GP because we can phone up for advice. Like many people, I have used the service in situations such as when one is anxious about a child late at night. I also welcome the shorter time taken in accident and emergency. We can now go in with a kid with an injury who can see a nurse, have an X-ray and be out within a couple of hours, which is phenomenal.
	While all that is happening, however, there are cuts to services because of deficits. We need a real understanding of what is happening. Our acute trust is in deficit for particular reasons, but not because it has been hugely incompetent. The financial management of the hospital has improved greatly, but it has experienced difficulties. Our PCT is in deficit, which has led to the mental health trust being made to take some of the strain.
	The kind of cuts that we have experienced include stopping all IVF treatment on the NHS, which puts it back to being subject to a postcode lottery, which is something against which I and others have campaigned for a long time. I think that the same thing has happened elsewhere. Several treatments have been cut, including some that are not so minor. There are proposals to cut all talking therapies in the mental health services and to cut access to certain drugs on NHS prescriptions.
	Although I will not take up my full time, Mr. Deputy Speaker, I must tell my right hon. Friend the Secretary of State that while I, like others, welcome the big pictureI think that it is wonderfula lot of people will focus on whether they can get the treatment that they want at the time that they want it. One might say that that is a little picture, but it is their picture and it is important to them, and that is why some of the cuts and the ways in which the deficits have been managed have been painful.
	Some will judge the situation on their perception of their job security, given that the NHS is a huge employer. Its staff also use its service, and it is really important that those involved in service design take the staff with them, but that has not happened, especially locally. We sometimes talk about service development as though it is about only new services and more money, but some aspects of it are intensely painful. For example, it is about moving services not only from the hospital to the community but, in my area, from the hospice to the community. Changes in palliative care mean that people want to die at home, but that might result in cuts in services at a hospice in which people might have seen their friends or family die and for which they might have raised funds. The process of change can thus be difficult.
	The Conservative party's focus on staff development is completely hypocritical. One of the big arguments about funding is that all the extra money that has gone to the NHS has not been properly spent. Yes, a lot of it has been spent on pay risesquite rightly soand that has of course affected the productivity figures. The pay increases have not been small. In London and the south-east during the 1990s, when I was chair of a community health council, the contract staff who cleaned hospitals in the NHS were on 2 an hour. The increase in salary up to the minimum wage and beyond affects the unit cost of all work done in hospitals.
	It is also not true that deficits are something new. When I was first selected as a candidate in Northampton, the local health authority was faced with deficits in the financial year 1995-96 because it had overspent. It took the decision to keep the following year's spending on services the same and to hold reviews to deal with the funding problems. It simply carried out deficit budgeting, as it is known in local government, and rolled the deficit on. Deficits in the NHS are thus not new; what has changed is the way with which they are dealt.
	If the public ever fell for the Conservative party's blandishments about the NHS, they would live bitterly to regret it. There is no doubt that ours is the party that has always delivered for the NHS, and that is what got many of us into politics. I remind my right hon. Friend the Secretary of State, however, that we must not just make change, but manage change. We must take the public with us and we must recognise that treatments that might seem minor to us are major to the people at the receiving end. It is important that people's experience of the NHS is that they receive the treatment that they want, that they can talk through the process and that they can see clearly that the NHS is safe in Labour's hands.

Crispin Blunt: May I say what a pleasure it is to see the Secretary of State grace the end of the debate in such sartorially elegant fashion? I wish that I could be as gallant about what she has done to hospital provision in my Reigate constituency, but I am afraid that I cannot.
	The debate has been characterised by a remarkable contrast. A number of Government Members have said how splendid things are in their constituency and how cross they are about the prospect of their budgets being put at risk so that deficits can be dealt withdeficits that, by a remarkable coincidence, seem to be in trusts represented by Conservative Members. It is beyond belief that all the incompetent NHS managers have ended up in Conservative constituencies, while all the brilliant managers have somehow ended up in Labour constituencies. The principal acute trust in my constituencySurrey and Sussex Healthcare NHS Trustis about to appoint its seventh chief executive since 1997. It may be the sixth chief executiveI may be one out, as it is easy to lose count.
	I shall speak in strong support of the proposals that my right hon. Friend the Member for Witney (Mr. Cameron) and my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) made about the independence of the health service. The speech of the hon. Member for Waveney (Mr. Blizzard) was instructive. He wanted the ability to interfere politically in the provision of health care in his constituency. What happened in my constituency is nothing short of a disgrace. On 19 December last year, the Secretary of State overturned a recommendation for a new hospital in Sutton in favour of a new hospital at St. Helier, at the explicit request of her hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) solely on the basis of evidence provided by the hon. Lady.
	Earlier in our debate, the Secretary of State told us that she took that decision on the basis of health inequalities. The only problem with that explanation is that she received advice that directly contradicts that explanation from her own adviser on the NHS in London, Dr. Sue Atkinson, on health inequalities and the merits of that decision. Dr. Atkinson's advice to the Secretary of State was unequivocal:
	I recommend that you should therefore accept the judgment of the local NHS on the location of the Critical Care Hospital...to be at Sutton.
	The hon. Member for Wyre Forest (Dr. Taylor) made the point that decisions in which the Secretary of State had intervened had not been referred to the independent reconfiguration panel, and nor was the decision in my area. I have to tell the hon. Gentleman that there is a case for independent review when the Secretary of State intends to overrule the decision of the local health community. If the Secretary of State is minded to accept a recommendationin this case, the unanimous decision of the local medical establishment that a new hospital at Sutton was the right decisionI do not think that there is a case for the Secretary of State to go to the independent reconfiguration panel.
	The Secretary of State's decision was so outrageous that Reigate and Banstead borough council and Surrey county council decided, having taken counsel's advice, to seek judicial review of that decision because it was unreasonable. The first stage of the process was complete, a case to answer was identified and a court date had been set, but on 16 August the Secretary of State reversed her decision, pending another review. That is one of the cover-ups that always goes on when there has been political interference. That case was direct political interference in the interests of the Labour party in Mitcham and Morden: I can say that because the Government have form, as the same thing happened at the southern end of my constituency. I notice that the hon. Member for Crawley (Laura Moffatt) is present. We have had this debate on numerous occasions and I will not repeat it now, except to say that one month before the 2001 general election, the Secretary of State directly interfered, at the request of the hon. Member for Crawley, to affect a decision in the political interests of the Labour party in Crawley.
	The hon. Lady has defended herself, saying that she will go on intervening to defend her constituents' interests. I know, as well as she does, that what she did was not in the interests of her constituents or of all the people who were being provided with acute hospital care in the area. It was not the right decision, and it has taken another four or five years for Crawley hospital to be extracted from the provision of acute care by the acute hospital trust. I am delighted that it is now the responsibility of the hon. Lady's local primary care trust, and it is now out of the hair of the managers who are trying to provide acute hospital care.

Laura Moffatt: It probably is right that the hon. Gentleman give way, so that I can give the House my account, rather than his account of what he thinks I was doing. I will continue to campaign, and the hon. Gentleman should be very careful because we need to be very guarded about his interference, using his local authority to promote the idea of legal challenge.

Crispin Blunt: In 2001, the hon. Lady enjoyed the benefit of that political interference, and in the 2005 general election she enjoyed the biggest swing in the country against a Labour candidate. The people of Crawley rumbled her and she was very nearly replaced as their Member in this Househer majority was only 32 votes.
	It is essential that we stop this party political interference in the management of health. My hon. Friend the Member for Hammersmith and Fulham (Mr. Hands) has been surprised to discover that Ravenscourt hospital, which was saved three years ago, is suddenly now being closed by this Government. Why? What has changed? The political party representing the constituency of Hammersmith and Fulham is the only thing that has changed.
	We must move to a system that our constituents can have confidence in, in which the money being spent clearly reflects health needs. I absolutely commend the splitting of public health provision to address directly the issues of health inequalities. The acute provisionthe critical care provisionshould then be done on a properly assessed basis. Haste the day that we can get to that point and take the corruption of party politics out of the provision of health care in this country.

Grant Shapps: I am grateful to be speaking at the end of what has been a very interesting debate, characterised by Labour Members telling us that everything is well, and Opposition Members pointing out problems. As ever, the truth probably lies somewhere in between. However, the specific subject of the debate is staff cuts and the surrounding financial environment, on which I wish to touch briefly.
	There are many different ways in which the constraints on the health service are impacting on the way that it is run. I am very pleased that the Secretary of State is in her seat, so that I can mention one of them. Sterilisation of instruments is increasingly being centralised and as that is happening, operations are being cancelled, which is decreasing the efficiency of the health service. Next Monday, a report will be published showing a 21 per cent. increase in the number of operations cancelled, purely as a result of the centralisation of sterilisation of instruments used in operations.
	I have a letter from a constituent who said that last week, she was in the Queen Elizabeth II hospital in Welwyn Garden City waiting for her operation. She came in the day before, so she used a hospital bed, in which she was put up overnight. A high-dependency bed was booked for her the day after her operation. She spent the entire day in the waiting roomthe anteroom, as she calls itawaiting surgery, only to be told that the operating implements were dirty and that no more could be obtained in time.
	It was not only my constituent's operation that was cancelled that day; 10 others were also cancelled. Surely it cannot be longit has probably already happened in the QEII hospital and elsewhere where centralisation is taking placebefore somebody is on the operating table and is cut open, only for it to be found that an instrument of a different size or nature is required to finish the task. I know that that happens in operationsI once had my clavicle operated on, and exactly that happened. If no instruments are available, the person has to be sewn back together and told to come back another day. I tell the Secretary of State that that is an unacceptable situation, which is a direct consequence of the financial crisis that we are experiencing.
	Another fact, sourced through a freedom of information request, is that there has been a 40 per cent. increase in the number of operations cancelled merely for administrative reasons, because, for example, the operating theatre had not been booked or the patient's notes not senteven because the patient had not been told that the operation would be taking place. In a period of only three years, a 40 per cent. increase in cancelled operations for such reasons is of real concern.
	I would appreciate the Secretary of State taking this point on board: 640 operations are cancelled every day, simply due to administrative cock-up640 throughout the NHS. That is a huge figure. On Monday, I shall be supplying her with the figures, so that she can see for herself. They have been obtained from all the hospital trusts through the freedom of information procedure, and I shall be interested to know what action the right hon. Lady intends to take.
	Time is short, so I shall conclude by mentioning Hatfield hospital. The Secretary of State will be aware that her predecessor visited Hatfield before the election when a Health Minister held my seat with a dodgy majority. The then Secretary of State for Health promised us a 0.5 billion new private finance initiative hospital at Hatfield. What happened? When I defeated the incumbent Labour Health Minister, the plan for that hospital disappeared [Interruption.] If I am wrong I shall be interested to hear the Secretary of State's response.
	Not only has that shiny new 0.5 billion hospital plan gone, but the existing Queen Elizabeth II hospital in Welwyn Garden City, which is supposed to support all the present population plus an expanded population, because we are told that we need to build tens of thousands of new homes, is being chopped away bit by bit. We are about to lose A and E, maternity, paediatrics and much more besides. That simply does not add up. I ask the Secretary of State to respond when she has the opportunity and I hope that she will take these matters more seriously than some of her Back Benchers, who have been laughing them off all afternoon.

James Gray: When the hon. Member for Hackney, South and Shoreditch (Meg Hillier) spoke, she was very content about the fact that her PCT was breaking even. However, she failed to mention one vital fact: every person in Hackney has 2,000 a year spent on them. In the Prime Minister's constituency, the amount is 1,300 a year and the average for England is 1,200, while in my constituency the average is only 900 a year. It is thus hardly surprising to discover that my PCT is 43 million in deficit across the SHA and that, as a result, health provision in North Wiltshire is in a deep and damaging crisis.
	It was tragic to drive past Malmesbury hospital the other day and see the barriers behind which it was being demolished. It is tragic to hear that maternity services at Chippenham are so badly underfunded that there are no staff, so the services can no longer be provided. It is tragic that according to a consultation paper currently out for consideration up to seven community hospitals across the county of Wiltshire could be closed. It is tragic that the Royal United hospital in Bath, which serves my constituency, is laying off about 300 people and closing 60 beds, and that the Great Western hospital in Swindon is laying off 198 people.
	When we put all those facts alongside the failure to provide dentistry and proper GP services in parts of my rural constituency, they amount to a significant crisis in health care in North Wiltshire. Whether that is the fault of the Labour party, senior managers or me, I know not, but I can tell the Secretary of State one thing in the few moments remaining for my speech: if she thinks that the NHS is having its best-ever year, I challenge her to visit North Wiltshire and see what I see in my constituency surgery every Saturday. Let her go to Malmesbury hospital, now being destroyed, to Chippenham hospital where destruction is imminent and to the seven hospitals in my area that are threatened with closure and then tell me that all is well with the health service in Wiltshire.

Stephen O'Brien: After a full day's debate in Opposition time, we have covered an enormous range of issues on the NHS, with particular focus on the NHS work force. I hope that the Minister of State, the hon. Member for Leigh (Andy Burnham), and I can do something novel and avoid the ritual ding-dong that tends to happen on these occasions. The Minister gets the last word, so if I refrain from the ding, it is no guarantee that he will refrain from the dong.
	The temptation is to revert, as always, to the tired old slanging match of me pointing out the failures and disappointments of the Government's policies on the NHS and the Minister reading out his prepared false accusations to the effect that we want to take money out of the NHS, when we are clearly committed to precisely the opposite. My right hon. Friend the Leader of the Opposition confirmed that only two days ago when he said that all parties supported increased NHS funding. It is worth taking the risk and seeing whether the Minister will respond to the genuine concerns and worries that have been raised in our important and timely debate.
	Our debate on the vital issue of our NHS work force was ably opened by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley). I am confident that I speak for the whole House when I pay tribute to all the medical professionalsthe nurses, the therapists and practitioners in our NHS. As my hon. Friend said, they do excellent work on which we all relymy family no less than any other, as we have very good reason to be eternally grateful to NHS professionals and carers.
	After my hon. Friend's excellent opening speech, we heard from the Chairman of the Select Committee, the right hon. Member for Rother Valley (Mr. Barron), who called for more evidence to build on some of the anecdotal points. I do not see him in his place, but he rather uncharacteristically spent his time hair splitting on the semantics of whether we are talking about posts or jobs in the NHS.
	Our debate is more likely to be remembered for the outstanding contributions of two former Secretaries of State for Health, my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) and my right hon. Friend the Member for Charnwood (Mr. Dorrell). My right hon. and learned Friend the Member for Rushcliffe rightly said that there was a remarkable consensus about the partnership approach that we all adopt to supporting the NHS. He also rightly argued that, because of some of the Government's actions and despite good will, we are in danger of seeing reform being given a bad name, when we need the money and reform to ride together. He was particularly concerned about the short-term expediency forced on so many NHS organisations through financial pressures and cuts. His major point was that those factors are unlikely to lead to greater efficiencies, so productivity is damageda point strongly reinforced by my right hon. Friend the Member for Charnwood when he said that a once in a lifetime chance to reform the NHS and its productivity had been fluffed. He argued that it was important to challenge moves to take resources out of community services, which represent an easy hit for a Government attempting to correct financial incompetence.
	Those two remarkable speeches were followed by that of the hon. Member for Pendle (Mr. Prentice), who reminded usmore a revelation than a reminder for Opposition Membersthat at the parliamentary Labour party meeting on Monday, the Prime Minister had urged Labour MPs to attack Conservatives on the so-called marketisation agenda, as the Prime Minister is alleged to have put it. The hon. Member for Pendle thought, Goodness me, recognising that that seemed to be the pot calling the kettle black. Moreover, he then said that the Government had Maoist tendencies in pursuing a ceaseless recovery and reorganisation programme.
	My right hon. and hon. Friends made many good speeches. My right hon. Friend the Member for East Hampshire (Mr. Mates) spoke about the importance of continuing commitment to our community hospitals and my hon. Friend the Member for Mid-Sussex (Mr. Soames) coupled praise for local NHS staff with concern for the future of medical provision in his area.
	My hon. Friend the Member for West Chelmsford (Mr. Burns) made a very powerful and balanced speech about delay to a new facility, despite all the promises that had gone before, and the necessary closure of an organisationsomething that he supported, so long as it was replaced by anotherand about the disappointment that has attended the process. The speech that followed was a plea by my hon. Friend the Member for Banbury (Tony Baldry) not to downgrade the Horton general district hospital in his constituency.
	Many Labour Members spoke, but it would take up too much time to recite the points that they were seeking to make. However, it was a question of deciding at what point in the 10 minutes allocated to all Back-Bench Members that the rose-tinted spectacles fell and the word but was used to launch the plea that they wanted to make about their own constituencies to try to stop the Government doing what they were about to do, or to ask the Government to do something that they had already indicated that they were not prepared to do. That was quite characteristic and particularly notable in the speech of the hon. Member for Bedford (Patrick Hall). However, it is fair to say that there were some honourable exceptions, not least the hon. Member for Pendle, but also the hon. Member for Northampton, North (Ms Keeble), who spoke quite late in the debate and made a constructive set of criticisms, to which I hope Ministers were listening carefully.

Rob Marris: To try to avoid the ding-dong to which the hon. Gentleman refers and in the interests of trying to make the NHS better, will he tell us what three steps the Conservative party would take to improve productivity in the NHS?

Stephen O'Brien: It is very interesting that, ever since I have been a Member, the hon. Gentleman has always asked that question, whatever the subject. He ought to reflect on the very significant and strategic offer that my party is makingto try to remove the politics from the NHS, to stop politicians from meddling in the NHS and to create independencewhich is in sharp distinction to the view expressed by the hon. Member for Waveney (Mr. Blizzard), who proclaimed himself the arch meddler in the NHS.
	Numerous other speeches were made, but time does not allow me to go into them. Instead, it would be helpful to hear serious responses from the Minister to the serious questions about the NHS work force, whose morale is being sapped by the concerns that are now attendant to all NHS organisations. Will he postpone the full implementation of the European working time directive from 2009 to 2012? I am sure that he can ask the Secretary of State about that, because she was responsible for those negotiations when at the Department of Trade and Industry. She now has responsibility for what we hope at the very least will be a push to amend the directive, given its effect, so that the challenges that now face NHS doctors can be met.
	Will nurses and physiotherapists now be guaranteed a year's employment, following their training, as happens in Scotland? At the moment, many people who have chosen to dedicate themselves to those professions find that they are not given the opportunity to build their experience immediately after they finish training. That is having a major effect on their employability, as they require hands-on experience to progress to become essential members of the NHS work force.
	It would be very helpful if the Minister could tell us what evidence the Government have to show the true causes of job losses, redundancies, lost posts and the freeze on filling vacancies. Given the constraints, the financial crises that exist in so many of our NHS organisations, the working time directive and the staff shortages, what are the financial effects as against the desire to improve patient care and safety? Let it be said that no one is against all change, but change should take place only to improve patient care and patient safety, not for short-term expediency, to cover a financial crisis caused by financial incompetence.
	On the NHS work force, we also have concerns about, for example, school nurses, hospital chaplains and dentists, but it is important to ask the Minister to ensure that he answers the specific, serious questions that have been asked today. That is what is required to make the NHS improve and build on the best.

Andy Burnham: This has been a lively and entertaining debate with a range of excellent contributions. Many of the contributions from Labour Members have told of an improving NHS that is on the way to ending long waits and that has new facilities and services. There have been measured contributions from the Opposition Members who sought to take a balanced view of how we see through some of the challenges that the NHS faces. We have also had, however, the road-to-Damascus speeches from the newfound defenders of the NHS on the Conservative Benches. Every single one of them without exception stood at the last election on a pledge to take money out of the NHS through the patient's passport. Today we hear a different tune, and that gives the electorate a problem. Who means it and who does not? To help the House, perhaps we could have a show of hands from those who have had a genuine change of heart about the NHS since the last election and those who are just saying anything to get elected. Perhaps we could see that now, or perhaps we will have to wait.

Gregory Barker: Will the Minister tell me what improvements there will be to the health service from making 2,000 expectant mothers every year travel 20 miles from Hastings, which is an area of social deprivation, and the surrounding area to the district general hospital in Eastbourne? What is improving the health service about that?

Andy Burnham: The hon. Gentleman is alone if he thinks that there have been no improvements to the health service and his hon. Friends have pointed them out today.
	I will come to the politics later, but I first want to strike a note of consensus. The shadow Health Secretary talked about independence and he was right to uphold the independence of the National Institute for Health and Clinical Excellence in supporting the difficult job that it does. I applaud him for that.
	The hon. Member for Northavon (Steve Webb) made some important points.

Martin Horwood: rose

Andy Burnham: I will not give way as I have not much time.
	The hon. Member for Northavon raised questions about independent sector treatment centres. May I point out that we pay significantly less for operations done through the private sector using this system than the extra premium that was paid in the past? He mentioned physios, as did many others, and there are genuine issues there. We are working with the Chartered Society of Physiotherapy to address these matters. We have removed physiotherapy from the list of shortage occupations for work permits and are working with NHS employers to make more junior posts available. However, I take his point on that.
	The hon. Member for Wyre Forest (Dr. Taylor) made a measured and important speech. He more than anybody knows the interplay between the NHS and politics and the important issues that that raises. He congratulated my right hon. Friend the Secretary of State on the referral of more cases to the independent reconfiguration panel and he had important things to say about urgent care and the delivery of urgent medicine without necessarily having to have the back-up of other acute facilities. I look forward to hearing how his meeting with the NHS chief executive goes.
	The hon. Gentleman made points about the private sector, as did my hon. Friend the Member for Pendle (Mr. Prentice). I assume that the hon. Gentleman's constituents are like mine and want 18-week maximum waits for treatment from the end of 2008. I also assume that he does not want stranded NHS capacity all round the country once we have met that target, so I hope that he will take it on board that, when it is sensible to use the private sector to help the NHS, we will continue to do so.
	My right hon. Friend the Member for Rother Valley (Mr. Barron) authoritatively demolished the Tory campaign pack that was mentioned in the debate. He shredded the figure of 20,000 job losses. People can draw their own conclusions, but it is dangerous information that the Tories are seeking to put into the public domain. My hon. Friends the Members for Dudley, North (Mr. Austin) and for Burnley (Kitty Ussher) did a forensic analysis of Tory health policy and the dissembling statements from the Conservative party. They tore them to pieces.
	My hon. Friend the Members for Wigan (Mr. Turner), for Hackney, South and Shoreditch (Meg Hillier), for City of Durham (Dr. Blackman-Woods) and for Kingston upon Hull, North (Ms Johnson) made excellent speeches and powerful arguments against the moving of funding away from the parts of the country that have the most severe health inequalities, as has been advocated in the Opposition's policy document. I am sure that the whole House will have heard their comments.
	My hon. Friend the Member for Waveney (Mr. Blizzard) was in the middle of praising the James Paget hospital when there was an astonishing moment. The hon. Member for West Chelmsford (Mr. Burns), for whom I have great respect, intervened to ask my hon. Friend to comment on a rumour about a hospital being scheduled for closure. My hon. Friend batted it away, but we have seen a new political tactic of circulating rumours about hospitals, even on the Floor of this House.

Simon Burns: Will the Minister give way?

Andy Burnham: I will not give way. We saw the tactic used by the Liberal Democrats at the last election

Simon Burns: Will the Minister give way?

Andy Burnham: I will not give way. It was a tactic used by the Liberal Democrats at the last general election regarding Christie hospital in Manchester, Withington, which led to Keith Bradley losing his seat. My hon. Friend the Member for Bedford (Patrick Hall) also mentioned how rumours have been started about Bedford hospital that he says have no truth. He too raised points about the serious issues facing NHS finance, which were echoed by my hon. Friend the Member for Northampton, North (Ms Keeble). I assure him that I took on board what he had to say, and we will return to the points that he raised.
	Having started a rumour about someone else's hospital, the hon. Member for West Chelmsford made a plea for his own, and I will look at the points that he raised about the PFI scheme in his constituency.
	Then we had two former Tory Health Secretaries. One, the right hon. and learned Member for Rushcliffe (Mr. Clarke), amazingly in a debate on the NHS work force and issues to do with NHS staff, attacked Agenda for Change and the system that has delivered better pay for thousands of workers in this country. It was unbelievable.

Kenneth Clarke: Will the hon. Gentleman give way?

Andy Burnham: I will not give way. I almost had to pinch myself. In a debate on NHS staff, a Tory Member of Parliament was taking away the credit for paying cleaners and porters more than the pittance that they received under his Government. What else can we expect from a member of a Government who called ambulance workers glorified taxi drivers?

Kenneth Clarke: On the Government's own figures, at least 600 million of the amount that was needed for all those pay rises was not provided to NHS employers, and that probably more than anything else has led to the financial crisis that they are all facing. Is that the way to run the human resources policy and the budgeting of the biggest employer in western Europe?

Andy Burnham: Such points are left to local discretion. The right hon. and learned Gentleman is compounding the point: he is again making an argument against Agenda for Change during a Conservative-inspired debate on protection for NHS staff. Today's pose is that the Tories are the friends of NHS staff. Their campaign pack has a petition, no less, to show support for the staff of our NHS. NHS staff will remember driving past advertising billboards at the last election. How hard is it to clean a hospital? the Tories sneered from those billboards. It was a derogatory swipe at NHS cleaners that was no doubt authorised by one of the campaign chiefs, Mr. Bring me sunshine himself, the right hon. Member for Witney (Mr. Cameron). We see in the campaign pack a tissue of inaccurate figures and shameless contradictionsa document that is completely intellectually dishonest. Like the right hon. Gentleman, I have not done many real jobs in my life, but I was once responsible for preparing such documents, and that is one of the worst of its kind that I have seen.
	On fairer funding, the document urges councils to pass a motion to provide funding to reflect accurately the burden of disease, but then it urges Tory activists to criticise the funding given to Greater Manchester primary care trusts, which have the lowest life expectancy in the country, where people get sicker younger, and where there are more people living with chronic disease. The Tory version of fairer funding means taking funding from areas such as Greater Manchester. Will the hon. Member for Altrincham and Sale, West (Mr. Brady) be campaigning this weekend on that dodgy document? I very much doubt it.
	The big and subtle deception is the pretence that the NHS

Patrick McLoughlin: rose in his place and claimed to move, That the Question be now put.
	 Question, That the Question be now put,  put and agreed to.
	 Question put accordingly, That the original words stand part of the Question:
	 The House proceeded to a Division.

Mr. Deputy Speaker: Order. Will the Serjeant at Arms investigate the delay in the Aye Lobby?

The House having divided: Ayes 230, Noes 302.

Question accordingly negatived.
	 Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
	Mr. Deputy Speaker  forthwith declared the main Question, as amended, to be agreed to.
	 Resolved,
	That this House welcomes the Government's historic investment in the NHS since 1997, trebling funding by 2008; pays tribute to the commitment of NHS staff; recognises the ongoing investment in their training and development; notes that there are now 32,000 more doctors and 85,000 more nurses, and that overall there are over 300,000 more staff working in the NHS; acknowledges that as a result of the Government's investment and reforms and the hard work and dedication of NHS staff, virtually no-one now waits more than six months for their operation whereas in 1997, 284,000 people waited longer than six months with some patients waiting up to two years; further notes that over 99 per cent. of people with suspected cancer are now seen by a specialist within two weeks of being referred by their general practitioner, up from 63 per cent. in 1997, and that death rates from cancer and heart disease are falling faster than ever before; and further recognises the need to ensure NHS services continue to change to benefit from new medical technologies and treatments which mean more care can be delivered in local communities and people's homes.

MUSEUMS AND GALLERIES (FUNDING)

Motion made, and Question proposed, That this House do now adjourn. [Liz Blackman.]

Patrick Cormack: I am grateful to have this opportunity to raise an important subject, which is obviously dear to the heart of most of my hon. Friends. However, I am glad to see that my friend, the hon. Member for Stoke-on-Trent, Central (Mark Fisher) is in his place, and I hope that he has the good fortune to catch your eye after I have made my remarks, Mr. Deputy Speaker. I am also delighted that the Minister is here.
	Anybody who visits London at the moment could be forgiven for thinking that our museums and galleries are in a fine state. There are three wonderful exhibitions: there is Holbein at the Tate; there is Velzquez at the National Gallery, which is due to open next week; and there is Rodin at the Royal Academy. Those are exhibitions of world class and importance, and they add lustre to our capital city. However, they do not tell the whole story, because our museums and galleries face a crisis, although it is not the first crisis that they have faced in my 36 years in this House. Indeed, 30 years ago in 1976, I produced a book, Heritage in danger, in which I sought to outline some of the difficulties facing our museums, galleries, country houses and churches at that time. At that time, I was writing shortly after the sale of the first 1 million picture, which had escaped the National Gallery. I was also writing before we had a National Heritage Memorial Fund and long before we had a lottery. Progress has therefore been made. One is grateful for things that successive Governments have done. None of the exhibitions to which I referred a few moments ago could take place without the Government indemnity that is available for our great national museums and institutions.
	As I speak, however, all the directors of those national museums and galleries are being asked how they could cut 7 per cent. of their annual budget. I appreciate that that is the beginning of a negotiating position, but it does not augur well. As the national art collections fund, or the Art Fund, as it is more popularly known, has pointed out, even were there a standstill on funding for the next three years, that would amount to a 15 per cent. cut in real terms. That is a danger and a worry to the staff who work in those museums and galleries, and it endangers scholarship itself, which fortifies the great exhibitions to which I have referred and the many others that have been held in our great capital city and around the country over the past several years. Scholarship is an integral part of any great museum or gallery. If we take that away, we take away the intellectual underpinning, which would be a great disservice.
	To compound all that, our museums and galleries have no earmarked funds for acquisitions and have not had them since 1993. Again, as the Art Fund has pointed out, that dire situation is at a time when art prices are rocketing. I am not just talking about the Klimt that sold for some 73 million a few months ago but the wonderful Titian that has adorned the walls of the National Gallery for many years and is now withdrawn, about to be sold, with the price put on it varying between 60 million and 80 millionwho knows? Those are works of enormous importance, which we should seek to retain wherever possible.
	The situation is made even more dire by the fact that the National Heritage Memorial Fund's budget has been pared down to 5 million. We are told that it will be increased to 10 million, which is welcome. I was one of those who struggled to establish it, in the wake of Mentmore, and it began with an annual budget of 25 millionthat is getting on for 30 years ago. In 1995, the Heritage Lottery Fund gave 10 per cent. of its annual budget, amounting to 18.5 million, towards acquisitions for museums and galleries. In the last full year for which figures are available, it gave 0.7 per cent.just 2.25 million. Also, the chairman has made it honestly plain that acquisitions are not a priority for the Heritage Lottery Fund. The Art Fundfor all the wonderful work that it does in galvanising public opinion and producing fine grantscannot really sustain what we need.
	It is not just museums and galleries that are affected but our national archives, from which we received representations making this point:
	The growth of a market for historical and literary manuscripts in recent years has not been matched by an increase in the resources available for the purchase of such collections.
	Wherever one looks, one finds that problem. The Art Fund also makes the point that museums and galleries may passively acquire things from time to time through generous gift or benefaction, but the intelligent creative process of building up collections by seeking out new works to complement existing ones has, for most, come to an end, even in London, the richest part of the country. As for the west midlands, from which the hon. Member for Stoke-on-Trent, Central and I come, that is one of the three poorest regions.
	Acceptance in lieu, which has been a godsend for museums and galleries over the years, is in danger, because if the owner of a great work of art has to re-roof his house, he is bound to be tempted by a buoyant market. Who can blame people for not choosing to go down the in lieu route?
	Why do we need new acquisitions? A paper submitted by the National Gallery to the Culture, Media and Sport Committee earlier this year stated:
	New acquisitions generate excitement, attract new audiences, and enliven the Gallery's education programme.
	The paper also points out that since the foundation of the National Gallery in 1824, Parliament has been at the forefront of acquisitions policy. We have a national duty and responsibility, which our forebears accepted and we must shoulder in our turn.
	I hope that the Minister, whom I am delighted to see in his place, will listen carefully to those who point out that museums and galleries now face far more significant ministerial interference in how they are run than they have for many years, but their funding becomes increasingly inadequate with each year that goes by. It may be argued that the sums are large, with one picture selling for 73 million. In the context of our national budget, those sums are tiny. Even in the context of the dome and, dare one say it, the Olympics, they are insignificant.
	I wish to place some solutions before the Minister this evening. The National Gallery, in its submission to the Committee, says that it would be helped immeasurably if its purchase grants were restored to 1983 levelsor just over 7 million. More than that could be done. The National Heritage Memorial Fund, which was set up originally as the land fund to commemorate those who gave their lives in the war, could and should be augmented. The Heritage Lottery Fund could be directed to give more money to acquisitions. It is not the Minister's particular responsibility, but the Government have plundered the lottery in a way that is regarded by many of those of us who helped to found it as shameful.
	The export reviewing committee is the body that examines works and decides whether they should be exported, and more are slipping through the net because the money is not available to retain them. The chairman of the committee, Lord Inglewood, has called for a national acquisitions fund. That is not a new idea, as it was first proposed by the Treasury in 1922.
	I ask the Minister to talk not only to the Secretary of State for Culture, Media and Sport, but to the Chancellor about new incentives. For example, we could extend the in lieu provisions to taxes other than inheritance, which could provide a great fillip at a time when the Government appear reluctant to provide the sort of sums that they should.
	We like to call ourselves a civilised nation. I believe that we are, but if we allow the great monuments of our forebears, symbolic of our civilisation, to fall into ruin, and if we allow our great museums and galleries, repositories of some of the greatest collections in the world, to stagnateset in amber with no new works addedwe are not fulfilling our duty as guardians of the civilisation of this nation. I hope that the Minister will be able to provide some crumbs of comfort in his replynot to me, because I do not matter at allbut to those who run our great museums and galleries and bear responsibility for our archives.
	I am not speaking in any partisan sense. I had the good fortune to help to found the all-party arts and heritage group in the mid-1970s to campaign against the wealth tax that was threatened at that time. The group still flourishes: I am its chairman, and the hon. Member for Stoke-on-Trent, Central is one of its officers. We have more than 300 members, in both Houses and of all parties. We go out to look at exhibitions or gather in Committee Rooms upstairs to listen to the curators and directors of our museums and galleries. I did not consult with every one of them before making this speech, but I have little doubt that all of them would endorse it.
	Dr. Charles Saumarez Smith is the director of the National Gallery. It is as a result of his presentation a few months ago that the hon. Member for Stoke-on-Trent, Central and I decided to try for a debate in the House on this matter. I hope that it will help to bring to a wider public the fact that we face a crisis. I hope that the Minister will not respond by saying, as one of his very illustrious predecessors in the Labour party never did say, What crisis?

Mark Fisher: I congratulate the hon. Member for South Staffordshire (Sir Patrick Cormack) on securing this debate. I tried to do so, but had no success, whereas he has succeeded heroically. He has been generous enough to allow me a couple of minutes of his hard-won time.
	I do not disagree with a word of what the hon. Gentleman said. He has great knowledge and experience of these matters, and he has shown a tremendous understanding of them over the years. That is especially true of his contribution tonight, in which he highlighted the concrete problems of acquisition budgets and funding and also pinpointed the necessity that the acquisition process be underpinned by scholarship. That is a crucial matter, but too often forgotten. Without that scholarship, our great collections would be almost nothing: this country's great tradition of curatorship is threatened by the fact that so many posts are vacant, but we would be in a bad condition without it.
	The hon. Member for South Staffordshire has said everything admirably, and I have nothing to add apart from one further point that he did not have time to cover. I want to deal with the difficulties that the acquisition of contemporary art is faced with as a result of the problem that he described.
	Contemporary art has always been the Cinderella of the acquisition budget, but it has probably needed less money than, say, the Halifax Titian, which was mentioned earlier. However, if our national and regional galleries and museums do not buy contemporary art now, our children and grandchildren will look at this age and fall to wondering. They will see that we had great and extraordinary artists such as Anthony Gormley, Damien Hirst and Jenny Saville, but also that the work of those artists is not in our national collections. There will be a horrible gap, resembling the one evident when the Tate trustees would not buy European art just after the war. The Tate has an extraordinary collection of 20th century art, but the gap means that it cannot be a great international collection. However, that is not the fault of the present directors and curators.
	We need to acquire contemporary art. The scheme that allowed such acquisition was the one administered by the Contemporary Art Society, but it was funded by the arts lottery and was therefore time limited. The scheme expired last year, and nothing has replaced it.
	There are 15 regional museums and galleries in this countryincluding the ones in Wolverhampton, Birmingham, Southampton and the Towner gallery in Eastbourneand they are no longer able to buy contemporary art. That is a disaster. Moreover, the acquisition scheme disbursed small sums of money to curators that allowed them to travel abroad and meet agents and artists. The closure of the scheme means that they have had to cease all that activity. There is going to be an enormous gap in our regional arts galleries and museums. That is a very small problem in the context of a much larger, more important problem, but it is significant.
	I hope that, as the Minister goes to regional museums, he will ask them about that and hear from them how important it is that we buy the work of this generation of British artists, which happens to be a particularly fine generation, so that our children and grandchildren will look back and see what an age we lived in. If we do not replace that Society and Arts Council lottery schemeof course, the people who should do that are the people at the Arts Council, who just happen to be the administrators of the arts lottery scheme that pulled the plug on thingswe are going to be looking at an awfully bleak future.

David Lammy: I am grateful to the hon. Member for South Staffordshire (Sir Patrick Cormack) for raising the issue today and for the contribution from my hon. Friend the Member for Stoke-on-Trent, Central (Mark Fisher). Before I address the points that have been raised, may I say a few words setting out the Government's position and the great importance that we attach to this issue? Collections, and the acquisitions that feed them, are clearly, as we have heard, the lifeblood of our museums and galleries. They are the raison d'tre behind all the interpretative, curatorial and conservation work that museums and galleries do, and the rationale behind the educational and social programmes that they run. Without a living collection and the ebb and flow of new acquisitions and loans, a museum can start to lose its way to the point at which collections may stagnate and people may lose interest and stop coming to visit.
	However, collections cannot be seen in isolation. The most dazzling and ever-changing collection is of little use to anyone if it is not displayed and kept in safe and secure surroundings, if it is not interpreted, put in context and brought alive by expert curators, and if it is not conserved and, when necessary, restored by skilled technicians and craftsmen. That is why, since 1997, we have invested across the whole of the museums sector, and why we did not reverse the decision taken by the Conservative Government in 1992 to scrap ring-fenced acquisition funds. A one-size-fits-all approach to cultural spending was not right then and it is not right today either. Our starting point in cultural investment is that the professional people in the museums themselvesboth staff and trusteesare far better placed to decide how their resources should be allocated.
	This Government have absolutely nothing to apologise for on funding. With the greatest respect to the hon. Member for South Staffordshire, let us just consider the facts. Spending by my Department on our sponsored museums and galleries has increased from 205 million in 1997 to 294 million today. That is a real terms increase of nearly 16 per cent. By 2008, we will have invested 150 million in the renaissance in the regions programme. That is the first ever sustained programme of central Government investment in the infrastructure of our regional museums. I have visited Hull, Manchester, Liverpool and Newcastle to see that renaissance in the regions programme. It is absolutely wonderful to see how our regional museums are being revived, when they were really in quite a desperate condition before. There is a revitalisation of museums across the country, reversing decades of under-investment and equipping the museum work force with the skills that they need to thrive in the 21st century. That includes the training necessary to identify and acquire the contemporary art and artefacts that will revitalise our collections. The National Heritage Memorial Fundits grant from my Department will double next year, by the wayhas committed more than 135 million for acquisitions of cultural property since 1980, including more than 30 million for archive and special library collections.

Patrick Cormack: The Minister really cannot get away with that one. I have listened to quite a lot on which I would have liked to intervene, but the National Heritage Memorial FundI was one of those who helped to found itstarted off with a budget that was much bigger than the one that it is going to have at the end of the year. Of course, we welcome the extra 5 million, but the figure is still 15 million less than the 25 million that it had. We should not led the Minister pretend that that is a success, because it is not.

David Lammy: It is slightly misleading to say that the budget started off at 25 million. The money that is put into the pot is investment that grows year on year. We have sought to double the yearly sum from 5 million to 10 million. This is not as simplistic as saying that there was 25 million in year one, all of which was spent, and that there was then another 25 million, because the fund never worked like that. The fact is that we are doubling the sum. The hon. Gentleman is slightly skewing the perception of the facts.
	Of course, we have had the Heritage Lottery Fund since 1994. The fund has made grants to museums, galleries and archives of nearly 1.5 billion, including 141 million for museums and galleries for works of art and other objects. On top of that, several forms of tax relief are available to help private owners to give, and public institutions to receive, important cultural objects. The conditional exemption allows estates to defer settlement of inheritance tax bills in exchange for public access to fine works. Douceursor sweeteners, if one prefersmake private treaty sales of works of art to public institutions more tax effective.
	One of the most successful ways of utilising the generosity of the Treasury is of course the acceptance in lieu scheme, which the hon. Gentleman mentioned. I use the word generosity without irony because acceptance in lieu is in nearly every way the holy grail of public policy. Absolutely everybody is a winner under the scheme. Owners of pre-eminent works of art and artefacts have their inheritance tax demands discounted when they offer their works in lieu of cash to settle the bill. The work of art in question is then saved for the nation, with public access guaranteed for ever, and the museum to which it is allocated gains a fine work for its collection at no cost to its ever-stretched budget.
	Our experience is that the position of museums in this country is by no means as bleak as some would suggest. I certainly would not characterise the position as a crisis, or dire. Indeed, the national museums and galleries that are sponsored by my Department have never before in the history of this country had access to so much investment, and I do not think that any hon. Member, or indeed any gallery director, would challenge that statement.

Patrick Cormack: There are two here tonight.

David Lammy: The hon. Gentleman indicates that he would challenge the statement that museums in this country have never had as much investment as they have now. I am surprised by that because the facts do not bear that outI am sure that his maths is better than that.
	The situation is thanks to the Government's commitment to the sector and our belief that the best of our cultural heritage should be open to everyone, regardless of their background. The public repaid our faith by visiting in their tens of millions after the financial barrier of charging and the insidious snobbery of elitism were swept away. There was an almost 66 per cent. increase in attendance at museums that used to charge after that charge was waived. The hon. Gentleman says that the Government are meddling in our museums, but that is about ensuring that our museums are free. We wish to ensure that our museums receive people from socially excluded groups so that the collections are enjoyed not solely by the sort of people who are fortunate enough to grace the House, but by the people of this country. I make absolutely no apology as a Culture Minister for the fact that we wish to ensure that the collections are available for everyone to enjoy.

Patrick Cormack: I was campaigning for free admission to museums before the Minister was born.

David Lammy: Sadly, the hon. Gentleman's party did nothing about it. It took the election of a Labour Government in 1997 to take the issue seriously. I am sorry, but I will not take any lectures from him on that point.
	Grant in aid, self-generated income, business sponsorship and any number of grant schemes and tax concessions that either help directly or free up funds that museums and galleries can use have grown, as the hon. Gentleman knows. In addition, there is a safety net that helps to give UK institutions a second chance when pre-eminent items are threatened with export. For the record, I have used that mechanism on a number of occasions to ensure that valuable treasures remain in the country. Our system of export licence deferrals has remained pretty much the same for more than 50 years. It has the respect of the trade, as well as an international reputation for common sense and even-handedness.
	I am very pleased to be able to tell the House that, last year, more than 50 per cent of the items on which the Government put a temporary export stop were saved, in addition to the hundreds of items saved since the reviewing committee was set up by a previous Government in 1952. Exquisite pieces as varied as The Death of Actaeon by Titian, Canova's Three Graces, a 102-piece Svres dinner service presented to the Duke of Wellington, and the Macclesfield psalter have all been saved thanks to that system. They will remain in this country, with full public access, for ever. I therefore do not accept the hon. Gentleman's argument.
	I am not going to apologise for the Government's record on the arts, culture, museums and galleries. It holds up fantastically well in comparison with that of the previous Administration, of whom the hon. Gentleman was a member. He is right to highlight the issue of acquisitions and to raise matters about which museums feel keenly, but I am afraid that I must take issue with the manner in which he did so. He correctly pointed out that the international art market, on which museums have to trade, is something of a law unto itself. He is absolutely right.
	 The motion having been made after Seven o'clock, and the debate having continued for half an hour, Mr. Deputy Speaker  adjourned the House without Question put, pursuant to the Standing Order.
	 Adjourned at twelve minutes to Eight o'clock.